Field Geology Club of South Australia, Inc

~ Application For Membership ~


NAME:

Mr/Ms/Mrs ....................................................................................................................................................
(first name) (family name)

ADDRESS:

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........................................................................Postcode.................................

Phone Number.................................E-Mail:...............................................

TYPE OF MEMBERSHIP:

(please tick)

Adult.............. Family............. Organisation.............(Library, Club, School, Company)
Pensioner............. Student.............

SUBSCRIPTION

Rates Are:
$35 for adult, family or organisation membership and
$30 for pensioner or student membership

The full year extends from October 1st
Half yearly subscriptions are acceptable after March 31st for new members

Amount remitted: Cheque $...................Other $....................

Please send application form and payment to:

The Treasurer
Field Geology Club of South Australia Inc
P.O. Box 28, Marden, S.A. 5070
How did you learn about the Club?

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