NAME:________________________________________________

POSTAL ADDRESS:_______________________________________

_____________________________________________________

__________________________________POST CODE:__________

PHONE NOs:

Home: (___)___________Work: (___)__________Mobile: ________________

Email Address: _________________(if applicable)

MEMBERSHIP NUMBER:_________________

OCCUPATION:__________________________________

QUALIFICATIONS:_____________________________________________

___________________________________________________________

I would like to participate in (please tick): ( ) Tours Official, ( ) Publications,
( ) Exhibitions, ( ) Workdays, ( ) Technical, ( ) Administration.

Your comments regarding any facets of the Society and its operations would be much
appreciated:-___________________________________________________

_______________________________________________________________

Payment is being made by (please tick one):
( ) Money Order; ( ) Cheque; ( ) Credit Card (complete details below);
( ) Bank Cheque; ( ) Cash (For renewals at meetings/on tours only)
Please do not send cash through the post under any circumstances.

If paying by Card, please complete the following:
Card Type: ( ) VISA; ( ) Mastercard.

Card Number: __________________________ Expiry Date: ___ / ___

Name on Card: _________________________ Amount: $ _________

Amount Paid: $50 Donation: $______Total: $______

Authorisation Signature: ___________________________
Please make your cheque/money order in favour of "The Sydney Electric Train Society Inc".
______________________________________________________________

OFFICE USE ONLY:
Date received: _____/_____/_____ Receipt No:_________Cash/Cheque/Bank

Cheque/Money Order Bank + Branch: __________Cheque No: __________
Amount: $ _____________

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