Membership

MEMBERSHIP APPLICATION

MEMBERSHIP 2010 -2011

STILL ONLY AUD30.00 (WORLD-WIDE)

To become a member of this Society please copy and send this

Membership Application form to:

The Membership Secretary,

Phonograph Society of NSW Inc

414/6A Birtley Place

ELIZABETH BAY NSW 2011

AUSTRALIA

Please         enroll me as a member

OR              renew  my membership

                    (Please cross out whichever does not apply)

of The Phonograph Society of NSW Inc for financial year July 2010 -June2011.

Payment in the amount of AUD 30.00 (Thirty dollars  Australian currency) is being made as follows:

By cheque /bank draft/ money order (forwarded herewith)

OR by PayPal (through www.paypal.com directed to sales@phonographsociety.org )

OR cash (only if paying in person)

(please cross out whichever does not apply)

SIGNED:_____________________________________________________

NAME:_______________________________________________________

ADDRESS:____________________________________________________

CITY:______________________________________STATE:____________

COUNTRY:_______________________POSTCODE:__________________

PHONE:_________________________MOBILE:_____________________

EMAIL:_______________________________________________________

MY INTERESTS AND/OR CURRENT RESEARCH PROJECTS ARE:

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

IF YOU WOULD LIKE TO RECEIVE  FURTHER INFORMATION ON THE SOCIETY AND IT'S ACTIVITIES PLEASE
FILL OUT AND EMAIL THE FOLLOWING  DETAILS AND CLICK ON THE "SUBMIT' BUTTON.

    Please make sure that you fill in the boxes before clicking the submit  tag otherwise we will

        not receive your information...........................................