Name (required)

Surname (required)

Address (required)

Suburb (required)

State (required)

Postcode (required)

Phone number (required)

E-mail (required)

Membership type (required) ---Individual - $40Concession (student/pensioner) - $20

Is this a renewal? ---YesNo

Would you rather receive the newsletter by email or post? ---E-newsPrint

Subscription for Choir ($10.00 in addition to membership) ---YesNo

Message (optional)

-----

Membership costs $40 for individuals and $20 for pensioners. Please note that your membership will not be valid until we receive confirmation of payment.

You can pay by cheque or direct deposit into the following account:
Dante Alighieri Society
BSB: 082 902
Account No: 515 003 825
(Please include your surname and initials as reference when paying by EFT)

By filling in this form, you agree to abide by the rules and regulations of the Dante Alighieri Society (copies are available from the office on request).

- - - - -