JEMS Membership Form

Annual Membership from 1st June to 31st May Please print clearly. Cheques should be made payable to The Embroiderers’ Guild of SA Inc.  For return of your membership card and receipt, please enclose a stamped self-addressed envelope.  Fees must be paid by 30th June of the current year.

Name:……………………………………………………………………………………………………………………………………
Address:………………………………………………………………………………………………………………………………
Suburb:………………………………………………………………………………………Postcode:…………………………
Date of Birth:………………………… Telephone:………………………  Mobile:……………………………………

Emergency Contact (Essential):…………………………………………………………………………………………
Emergency Contact Telephone:…………………………………………………………………………………………

New Membership             ⃝         Renewal               ⃝

(Office use)
Membership No……………………………            Receipt No…………………………

SINGLE JEM’S MEMBERSHIP _______________________$ 64.00                ⃝
Includes: Membership; “Review”; Attendance Fee; Materials Fee

FAMILY MEMBERSHIP (1 Adult & 1 Jem at same address) $ 126.00             ⃝
Includes: As above PLUS Membership – Adult

MULTIPLE FAMILY MEMBERSHIP ___________________$ POA                   ⃝

pro rata fees apply

⃝           I enclose cash (please tender correct money)                     $………………

⃝           I enclose cheque/money order for                                         $………………

⃝           Bankcard             ⃝          Visa                       ⃝          MasterCard

Card Number _ _ _ _   _ _ _ _   _ _ _ _   _ _ _ _         Expiry Date……………………………

Full name as it appears on card……………………………………………………………………………………

Signature:………………………………………………………………………………………………………………………

Amount                $…………………………           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