Adelaide Technical High School Old Scholars Association Inc MEMBERSHIP SUBSCRIPTION / RENEWAL 1 January to 31 December 2012 TITLE PRESENT SURNAME SURNAME AT SCHOOL GIVEN NAMES YEARS Postal Address UNIT/NO STREET SUBURB STATE COUNTRY PCODE Residential Address (if different) HOME PHONE MOBILE OTHER () EMAIL @ Enrol me as a Financial Member for Year Ending 31st December 2012 - cost $30-00 Please accept my donation for $5 $10 $25 OR $ towards the Scholarship Fund I wish to receive the Newsletter by post. Record changes to my details Email me notification when a Newsletter is posted on the website: www.athsos.com.au Please note that your personal details will not be divulged to other Old Scholars except to those responsible for management of the Association or to any other person or organisation without your express permission. Payment Method None Payment Options: Please note that receipts will be issued only if requested. Members requiring receipts should include a stamped, self-addressed envelope with their completed Subscription Form. Subscription Cost $30 for Members and for Joint Membership. Cheque Money Order Please make cheques and money orders payable to ATHSOS Inc. AMOUNT $ Cash Card Number Expiry Date Visa /// / Mastercard Name on card (Please Print) Signature: ....................... EFT To BSB 105 125 Account 461 744 540 When processing, please include your name as a reference and please attach a copy of the deposit receipt to this form so that we know who made the deposit. Please post with completed form and Cheque, Money Order, Cash or EFT Deposit Slip to: Receipt No. Receipt Date Amount Ch/MO/Visa/MC/EFT Date Recorded The Treasurer ATHS Old Scholars Association PO Box 4041 NORWOOD SOUTH SA 5067
Adelaide Technical High School
Old Scholars Association Inc
MEMBERSHIP SUBSCRIPTION / RENEWAL
1 January to 31 December 2012
TITLE
PRESENT SURNAME
SURNAME AT SCHOOL
GIVEN NAMES
YEARS
Postal Address
UNIT/NO
STREET
SUBURB
STATE
COUNTRY
PCODE
Residential Address (if different)
HOME PHONE
MOBILE
OTHER
()
EMAIL
@
Enrol me as a Financial Member for Year Ending 31st December 2012 - cost $30-00
Please accept my donation for $5 $10 $25 OR $ towards the Scholarship Fund
I wish to receive the Newsletter by post. Record changes to my details
Email me notification when a Newsletter is posted on the website: www.athsos.com.au
Please note that your personal details will not be divulged to other Old Scholars except to those responsible for management of the Association or to any other person or organisation without your express permission.
Payment Method
None
Payment Options: Please note that receipts will be issued only if requested. Members requiring receipts should include a stamped, self-addressed envelope with their completed Subscription Form. Subscription Cost $30 for Members and for Joint Membership.
Payment Options: Please note that receipts will be issued only if requested. Members requiring receipts should include a stamped, self-addressed envelope with their completed Subscription Form.
Subscription Cost $30 for Members and for Joint Membership.
AMOUNT $
Cash Card Number Expiry Date
Visa /// /
Mastercard Name on card (Please Print) Signature: .......................
EFT To BSB 105 125 Account 461 744 540
When processing, please include your name as a reference and please attach a copy of the deposit receipt to this form so that we know who made the deposit.
Please post with completed form and Cheque, Money Order, Cash or EFT Deposit Slip to:
Receipt No.
Receipt Date
Amount
Ch/MO/Visa/MC/EFT
Date Recorded
The Treasurer
ATHS Old Scholars Association
PO Box 4041
NORWOOD SOUTH SA 5067