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Membership Form
Please print this form, complete the details and send it in with a cheque or money order for the appropriate membership fee.
The current full Membership year is from the 1st June 2011 to the 31st May 2012.
PLEASE INCLUDE A STAMPED, ADDRESSED ENVELOPE SO THAT YOUR RECEIPT CAN BE MAILED BACK TO YOU.
Date .................................................... Amount Enclosed ..................................
Subscription Type (City, Country, etc) ............................... New Member/Renewal
Branch (City, South Coast, etc) .............................................................................
Name ..................................................................................................................
Address ................................................................................................................
Phone .................................................................................................................
Mobile Phone ........................................................................................................
Email .....................................................................................................................
Emergency Contact:
Name ........................................................... Phone .........................................
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
The current full Membership year is from the 1st June 2011 to the 31st May 2012.
PLEASE INCLUDE A STAMPED, ADDRESSED ENVELOPE SO THAT YOUR RECEIPT CAN BE MAILED BACK TO YOU.
Date .................................................... Amount Enclosed ..................................
Subscription Type (City, Country, etc) ............................... New Member/Renewal
Branch (City, South Coast, etc) .............................................................................
Name ..................................................................................................................
Address ................................................................................................................
Phone .................................................................................................................
Mobile Phone ........................................................................................................
Email .....................................................................................................................
Emergency Contact:
Name ........................................................... Phone .........................................
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
