Please print a separate form for each class you wish to enrol in.
Complete the details and send the form(s) in with the class fee.

                 **** You will need a valid Yahoo email address to enrol in a Cyber Class ****

[   ]  I HAVE INCLUDED MY YAHOO EMAIL ADDRESS SO THAT MY RECEIPT AND CLASS LOGIN DETAILS CAN BE EMAILED TO ME.
[   ]  I HAVE READ, UNDERSTOOD AND AGREE TO THE COPYRIGHT TERMS LOCATED ON THE CYBER CLASS WEB PAGE.

Class  ............................................................................................................Date(s) of class  ....................................
 
Member Fee  $ ...............................   Non-member Fee  $ .......................................Kit Cost $ .................................      

Name .........................................................................................................................................................................  

Address  ....................................................................................................................................................................  

Phone ....................................................................................  Member / Non-member (Please circle as appropriate)  

Mobile Phone  ...........................................................................................................................................................  

Yahoo Email Address  ...............................................................................................................................................  

Date application lodged  ...........................................    Signature   ............................................................................

Payment by Cash [ ]  Cheque [ ]  Money Order [ ]  Mastercard [ ]  Visa [ ]  (please tick)

Card No. _ _ _ _ /_ _ _ _ /_ _ _ _ /_ _ _ _ Expiry date_ _ /_ _

**If you use your credit card we will need the last 3 numbers in the signature panel on reverse of card _ _ _

Cardholders Name.............................................................................Signature.................................................                                                                                                           Total Amount $.........................................
Return to: 
The Embroiderers' Guild of South Australia Inc.
16 Hughes Street
MILE END
South Australia 5031

Email: contact@embguildsa.org.au
Phone: (08) 8234 1104         International: +61 8 8234
Fax: (08) 8234 1513             International: +61 8 8234 1513