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