PERTH PC USERS GROUP Inc.
P.O.Box 46 PARKWOOD WA 6147
- Membership Application Form -
New Application[__] or Renewal[__] (Mem# ______) Change of
Details[__] (Mem#_____)
Membership Types: for
One Years membership (12 months from date of joining)
Individual *[__]$60 First
Year, thereafter *$50 per annum
Family [__]$60 + $10 per
extra family member, First Year, thereafter $50+$10
Corporate [__]$100 Up to
three nominees with 1 mag + same as Individual
(Note: Prices current
at time of publishing)
Mr. [__] Mrs. [__] Ms. [__] Other
____ Surname: ___________________
First Name(s): ____________________________________________________
Street (Number & Name):____________________________________________
Suburb: _______________________________________
State:_____________
Country: _______________________________________Postcode:__________
Telephone Home: _________________Work:_____________________________
Fax: __________________________Mobile: ____________________________
Email Address: ____________________________________________________
Company Name: _____________________________________________________
Occupation: _______________________________________________________
Can we use these details on a mailing list?
YES or NO _____________
Where did you hear about the PPCUG? _______________________________
Preferred name on membership card: _______________________________________________________
*Note: If your membership is in default you will be required to add a $10 rejoining
fee to your sub.
I/We hereby apply for membership New/Renewal
of the
Perth PC Users Group(Inc.) and agree to abide
by its rules
while I/We remain member(s).
Signed ___________________________________________Date
/ /
Payment details/credit card authority
Forward to (Email) treasurer@perthpcug.org.au
or Snail mail "The Treasurer", Perth PC Users Group, P.O.Box 46, PARKWOOD WA 6147
Name _______________________________________________________________
Home Postal Address ________________________________________________
________________________________________________Postcode
___________
Telephone Numbers BH:( )_______________AH:(
)_____________________
Cheque (payable to "Perth PC
Users Group Inc.") enclosed [__]
or Debit my credit card
Bankcard[__] Mastercard[__] or
Visa [__] with $___.__
Credit Card No.
___ ___ ___ ___ | ___ ___
___ ___ | ___ ___ ___ ___ | ___ ___ ___ ___
Expiry Date ___ / ___ Signature __________________Date
/ / 2007 |
