MEMBERSHIP APPLICATION 2010

You are invited to apply for membership of the Scandinavian Association of South Australia for the year to December 2010. Please fill out the details and mail this form with your cheque or money order, crossed ‘NOT NEGOTIABLE’ and made payable to “Scandinavian Association of SA Inc.”  to The Secretary, SASA, PO Box 153, HINDMARSH, SA 5007.  *Concession is granted to pensioners (concession card holders), country members living over 80 km from Adelaide, full time tertiary and secondary students, exchange students from overseas and newly arrived immigrants.

ALL MEMBERSHIPS INCLUDE ANNUAL SUBSCRIPTION (10 ISSUES)

TO THE NEWS MAGAZINE VIKINGEN.

 Applicant

Surname

First Name

Birthday (optional)

Nationality and/or connection with Scandinavia

Tel. home:

E-mail address

Tel work:

Address

Suburb/Town

Postcode

Co-Applicant/Partner

Surname

First Name

Birthday (optional)

Nationality and/or connection with Scandinavia

Tel. home:

E-mail address

Tel work:

Children

Surname

First Name

Birthday (optional)

Applicant’s signatures

1.Family $32  2.Single $22  3.Family Concession* $22  4.Single Concession* $17 

You can pay by direct deposit at NAB or internet banking, but remember to quote your name and mail or email this form if you are a new member.

Account: Scandinavian Assoc of SA

Bank: NAB   BSB: 085 446   Account: 20508 7760 

Total Payment enclosed