CANBERRA PHOTOGRAPHIC SOCIETY (INCORPORATED)

MEMBERSHIP APPLICATION

Please print out this form, fill out, sign and submit to the treasurer at a meeting;
or post with subscription to

GPO Box 857
Canberra ACT 2601

I/We apply for a new membership membership renewal

for

Individual($110) Family($160) Student / concession($50)

NOTE : Membership at the concession rate is only available to full time students and Australian disability or age pensioners. Proof of eligibility in the form of a valid student card or Australian Government Pensioner Concession Card is required.

of the Canberra Photographic Society (Incorporated) and agree to abide by the constitution and rules of the Society.

Mr Mrs Ms Dr Other[please specify]

SurnameGiven Name(s) .

Address:

Street

Suburb

City Postcode

Telephone Number (Work) (Home) .

Membership fee of $due.

Date

Please subscribe my email address to "Photon" the Canberra Photographic Society's email list so that I will receive up to date info about meetings, activities and about photographic events around the region. My email address will not be traded, sold or passed on to any other organisations or individuals.

Email address for Photon:

Email address for contact if different from above: