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P O Box 618 NOWRA NSW 2541
APS 2016 MEMBERSHIP RENEWAL FORM Card Number …………… Please print clearly. All adults who participate in the group activities should be covered by membership. Joint membership may include 2 adults who choose to use the same address. SURNAME 1……................................................. GIVEN NAME ...…..…...........……....…..… SURNAME 2...…...............................................… GIVEN NAME .........…….........……....…… MAILING ADDRESS …..…….………..…………………………………… PC………………. Change of address? (Circle) YES/NO Previous Postcode .……….......………………… EMAIL ADDRESS: please print clearly
.............................................................................................................................................. * I am willing and able to receive the colour version of the Nowra newsletter via email YES/ NO. Also send your email address to rapidpulse@bigpond.com PHONE: Home (__ __) __ __ __ __ __ __ __ __. Work: (__ __) __ __ __ __ __ __ __ __. FAX: (__ __) __ __ __ __ __ __ __ __. MOBILE: __ __ __ __ __ __ __ __ __ __ . TYPE OF MEMBERSHIP
Rates as at 1 January 2016 Includes GST. Please tick: INDIVIDUAL $53.00 ( ) Concession $45.00 ( ) JOINT MEMBERS $61.00 ( ) Concession $53.00 ( ) A concession is available to Seniors, people on a limited fixed income and full-time students. This applies in joint memberships where one person is entitled to request it. CHEQUE _ MONEY ORDER _ payable to Australian Plants Society, Nowra Group Or please charge my: Bankcard __ MasterCard __ Visa __ Card No: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Card Expiry Date ………. / ……...... NB Payment cannot be processed without date. 3 Numbers from the rear of card — — — Card Holder's Name ..…............................... Card Holder's Signature ............................................. Post payment and direct all membership problems/inquiries to:
Ken Smith
P.O. Box 140 Sanctuary Point NSW 2540 Phone: 4443 3497
Email: rapidpulse@bigpond.com NOWRA GROUP |