Field Geology Club of South Australia, Inc

~ Application For Membership ~

NAME:

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

ADDRESS:

...............................................................................................................................................

..........................................................................................................................................................

........................................................................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 $...................or Bank Transfer $....................

Bank Details: Field Geology Club SA.

BSB: 105 900 Account: 952 060 340

Please send application form and payment, or advice of bank transfer, to:

The Treasurer
Field Geology Club of South Australia Inc
17 Chicklade St, Elizabeth Vale, 5112.

How did you learn about the Club?