Membership Application Form
PLEASE PRINT AND SEND BY MAIL
FORMFB1
Society
of Women Writers
VICTORIA Inc.
A0039632B
73
CHURCH ROAD
CARRUM
VIC 3197
NAME......................................................................................................................................................................
ADDRESS...............................................................................................................................................................
TELEPHONE:
HOME..............................................................WORK......................................................................
FAX.................................................................EMAIL......................................................................
Would you like to receive your Newsletter via email yes _____ no _______
WRITING INTERESTS:...........................................................................................................................................
................................................................................................................................................................................
ACHIEVEMENTS:
(PLEASE ATTACH A SEPARATE SHEET IF SPACE
INSUFFICIENT).............................................................
................................................................................................................................................................................
................................................................................................................................................................................
................................................................................................................................................................................
................................................................................................................................................................................
................................................................................................................................................................................
PUBLISHED?
YES/NO.......................................................
SIGNATURE
OF
APPLICANT...........................................................................DATE........................................
SIGNATURE
OF
NOMINEE...............................................................................DATE........................................
SIGNATURE
OF
SECONDER...........................................................................DATE.........................................
FEES: All fees are shown in Australian Dollars.
Payment Methods: BY MAIL : please make out cheque/money order to SWWV and send with this slip to
Acting Treasurer, Shirley Whiteway ? 78 Abbott Street, Sandringham 3191
Enclose this slip with the exact amount in envelope and hand to Treasurer or Secretary. Please send a stamped addressed envelope if you want a receipt posted to you.