I, ...................................................................................................................................................................................................

(Full name of applicant)

of .....................................................................................................................................................................................................
(Home Address)

....................................................................................................................................................................................................
(Home Phone) (Home Fax) (Mobile Phone)

.....................................................................................................................................................................................................
(Work Address)

.....................................................................................................................................................................................................
(Work Phone) (Work Fax) (Occupation)

desire to become

*an individual member at a current annual subscription fee of $____.

*a concessional member at a current annual subscription fee of $______. because I am:

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

(Insert reason for seeking concessional membership. The Secretary may ask you for evidence of your claim)

*a member on behalf of my family at a current annual subscription fee of $Ö. that currently includes the following persons residing at my home address:-

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

(Provide details of names and ages of the family members included in your application)

*(choose one only)

of the 3D Society of Melbourne Australia Incorporated

I enclose the annual subscription of $_________ payable for the type of membership that I have indicated above.
In the event of my admission as a member, I agree to be bound by the Rules of the Association for the time being in force.

 

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Signature of Applicant

Date.........................................................................