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Class Enrolment Form
Please print a separate form for each class you wish to attend.
Complete the details and send the form(s) in with the class fee.
[ ] I HAVE ENCLOSED A STAMPED, SELF-ADDRESSED ENVELOPE SO THAT MY RECEIPT AND CLASS REQUIREMENTS CAN BE MAILED BACK TO ME
[ ] PLEASE PLACE MY RECEIPT AND CLASS REQUIREMENTS IN THE BOX IN THE GALLERY FOR COLLECTION
Class ......................................................................................................................
Date(s) of class ......................................................................................................
Deposit $ ................ Member Fee $ ................ Non-member Fee $ .................
Name ......................................................................................................................
Address .................................................................................................................
Phone ...................................... Member / Non-member (Please circle as appropriate)
Mobile Phone .........................................................................................................
Email ......................................................................................................................
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
Fax: (08) 8234 1513
Complete the details and send the form(s) in with the class fee.
[ ] I HAVE ENCLOSED A STAMPED, SELF-ADDRESSED ENVELOPE SO THAT MY RECEIPT AND CLASS REQUIREMENTS CAN BE MAILED BACK TO ME
[ ] PLEASE PLACE MY RECEIPT AND CLASS REQUIREMENTS IN THE BOX IN THE GALLERY FOR COLLECTION
Class ......................................................................................................................
Date(s) of class ......................................................................................................
Deposit $ ................ Member Fee $ ................ Non-member Fee $ .................
Name ......................................................................................................................
Address .................................................................................................................
Phone ...................................... Member / Non-member (Please circle as appropriate)
Mobile Phone .........................................................................................................
Email ......................................................................................................................
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
Fax: (08) 8234 1513
Office Use Only
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