|
THE ELECTORAL REFORM SOCIETY OF SOUTH AUSTRALIA (South Australian
Branch of the Proportional Representation Society of Australia) |
Membership
Application Form
|
Secretary:
Mr Deane Crabb |
Tel. (08) 8297 6441 [H] |
|
11 Yapinga
Street |
(08) 8100 8711 [W] |
|
SOUTH
PLYMPTON SA 5038 |
|
|
|
|
To the
Electoral Reform Society of South Australia * I wish to
remain on the mailing list. Yes/No (A $5 charge applies to those remaining on
the mailing list) * I apply
for/renew membership of the Electoral Reform Society of South Australia from
1st October to 30th September, and enclose $15.00, or $10.00 for pensioners
or full time students, as the Annual Subscription. * I apply for
Life Membership ($150) * I enclose a
donation of $....................... to the Society. * I
understand that membership also makes me a member of the Proportional Representation Society of Australia, of which
the Electoral Reform Society of South Australia is the South
Australian Branch. SIGNED:
......................................................
DATE: ................................ 20...... |
|
Title
(Mr/Dr/Mrs/Miss/Ms etc.) |
|
|
Given
Names |
|
|
Surname |
|
|
Address |
|
|
Postcode |
|
|
Private
Telephone No. |
|
|
Business
Telephone No. |
|
|
Private
Fax No. |
|
|
Business
Fax No. |
|
|
Mobile
Telephone No. |
|
|
E-mail
Address |
|
(Please make cheques
etc. payable "Electoral Reform Society of SA" and return to the
Secretary at the above address.
*************