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THE ELECTORAL REFORM SOCIETY OF (South Australian
Branch of the Proportional Representation Society of |
Membership Application Form
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Secretary: Mr Deane Crabb |
Tel. (08) 8297 6441 [H] |
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(08) 8100 8711 [W] |
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SOUTH PLYMPTON SA 5038 |
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To the Electoral Reform Society of South Australia * I wish to remain on
the mailing list. Yes/No (A $5 charge applies to those remaining on the
mailing list) * I apply for/renew membership of the Electoral Reform Society of South Australia from 1st October to 30th September, and enclose $15.00, or $10.00 for pensioners or full time students, as the Annual Subscription. * I apply for Life Membership ($150) * I enclose a donation of $....................... to the Society. * I understand that
membership also makes me a member of the Proportional
Representation Society of Australia, of which the Electoral Reform
Society of South Australia is the South Australian
Branch. SIGNED: ...................................................... DATE: ................................ 20...... |
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Title (Mr/Dr/Mrs/Miss/Ms etc.) |
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Given Names |
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Surname |
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Address |
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Postcode |
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Private Telephone No. |
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Business Telephone No. |
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Private Fax No. |
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Business Fax No. |
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Mobile Telephone No. |
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E-mail Address |
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(Please make cheques etc.
payable "Electoral Reform Society of SA" and return to the Secretary
at the above address.
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