Adelaide Technical High School Old Scholars Association Inc. MEMBERSHIP SUBSCRIPTION / RENEWAL - 2009 TITLE PRESENT SURNAME SURNAME AT SCHOOL GIVEN NAMES YEARS Mr Mrs Ms Miss Dr Rev UNIT/NO STREET SUBURB STATE COUNTRY PCODE Postal Address SA VIC TAS NSW ACT QLD WA NT Residential (if different) SA VIC TAS NSW ACT QLD WA NT HOME PHONE MOBILE FAX () () EMAIL @. Group box Enrol me as a Financial Member for Year 2009. $30-00 Accept my donation for $5 $10 $25 $ Other (Please tick the relevant box) I still wish to receive the newsletter / Record changes to my details Do not divulge my contact details to other old scholars without my permission. Email me notification when a newletter is posted on www.athsos.com.au Payment Method None Cheque AMOUNT $ Money Order Cash Card Number Expiry Date Name on card (Please Print) Visa /// / Mastercard Signature: ........................................................................ EFT To BSB 105 125 Account 461 744 540 When processing, please include you name as a reference and please attach a copy of the deposit receipt to this form so that we know to whom to made the deposit. Please post with completed form and Cheque, Money Order, Cash or EFT Deposit Slip to: The Treasurer ATHS Old Scholars Association PO Box 4041 NORWOOD SOUTH SA 5067 Receipt No. Receipt Date Amount Ch/MO/Visa/Mcd/DD Date Recorded
Adelaide Technical High School
Old Scholars Association Inc.
MEMBERSHIP SUBSCRIPTION / RENEWAL - 2009
TITLE
PRESENT SURNAME
SURNAME AT SCHOOL
GIVEN NAMES
YEARS
Mr Mrs Ms Miss Dr Rev
UNIT/NO
STREET
SUBURB
STATE
COUNTRY
PCODE
Postal Address
SA VIC TAS NSW ACT QLD WA NT
Residential (if different)
HOME PHONE
MOBILE
FAX
()
EMAIL
@.
Enrol me as a Financial Member for Year 2009. $30-00
Accept my donation for $5 $10 $25 $ Other (Please tick the relevant box)
I still wish to receive the newsletter / Record changes to my details
Do not divulge my contact details to other old scholars without my permission.
Email me notification when a newletter is posted on www.athsos.com.au
None
Cheque AMOUNT $
Money Order
Cash Card Number Expiry Date Name on card (Please Print)
Visa /// /
Mastercard Signature: ........................................................................
EFT To BSB 105 125 Account 461 744 540
When processing, please include you name as a reference and please attach a copy of the deposit receipt to this form so that we know to whom to made the deposit.
Please post with completed form and Cheque, Money Order, Cash or EFT Deposit Slip to:
The Treasurer
ATHS Old Scholars Association
PO Box 4041
NORWOOD SOUTH SA 5067
Receipt No.
Receipt Date
Amount
Ch/MO/Visa/Mcd/DD
Date Recorded