Save Albert Park - Membership Form

SAP Membership Form
Save Albert Park ~ aiming to relocate the Grand Prix to a permanent track ~

To become a member of Save Albert Park, please

phone our office (03 9690 3855)
or
print this page, complete the details below & post or fax it to us (PO Box 1300, South Melbourne DC, Victoria, 3205 ; fax 03 9690 3544)

..... members at $12/year ($6/year concession) plus a donation of $ ......... (optional) = Total $ ........

Name

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

Postal Address

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

Email Address (optional)

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

Occupation (optional)

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

Payment Method

Cheque or Money Order enclosed, payable to Save Albert Park (please circle)
or
Debit my Credit Card (please circle)
Bankcard Mastercard Visa

Card Number _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _ Expiry Date _ _ / _ _

Card Holder's Name

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

Signature

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

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© 1995 - 2000 Save Albert Park ; permission to copy is given provided this copyright notice is reproduced in full
Postal Address: PO Box 1300, South Melbourne DC, Victoria, Australia 3205
Telephone: 61 3 9690 3855 ; Fax: 61 3 9690 3544 ; Email: SAP (savap@bigpond.com)