Please print out this form and return it along with correct membership fee to:

Membership - OUT FM
Level 4
247 Flinders Lane
Melbourne
Victoria
Australia
3000

Name: .................................................................

Address: .............................................................

.......................................................................

Phone: ........................... Fax: ...............................

Email: ................................................................

Membership: (please circle)

		Adult Voting

		Concession Voting

		Adult Non-voting

		Concession Non-voting

($5 entrance fee is applicable)


Signed: ................................................................

Date: ...................................................................