BTL Membership Application Form 2012 by shitingting

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									                           2012 MEMBERSHIP APPLICATION
NAME AND ADDRESS
MOTHER’S DETAILS                                               FATHER’S DETAILS
Surname           __________________________                   Surname               _________________________
First Name        __________________________                   First Name            _________________________
Occupation/Special Skills           ______________             Occupation/Special Skills                    _____________
______________________________________                         _____________________________________
Address _____________________________________________________ Postcode___________
Phone Number _________________ Email ___________________________________________
How did you find out about Bayside Toy Library? ______________________________________
Which languages, other than English, are spoken at home? ________________________________


CHILDREN’S NAMES                                               The names of all children to be registered under 10 years old


Name                                                                                 Date of Birth

1.                                                                                               /          /
2.                                                                                               /          /
3.                                                                                               /          /
4.                                                                                               /          /


ROSTER DUTY                                                               Please tick all days you are available to do duty.


                  Wednesday         7:00 – 8:00 pm
                  Thursday          9:30 - 11:30 am
                  Friday            9:30 - 11:30 am
                  Saturday          9:30 - 11:30 am


If you know you are going to be away for one period during the year (eg you are expecting a baby or planning a trip),
please note the time and reason why below.
2011 MEMBERSHIP FEES
                         $70.00 for one child
                         $100.00 for two or more children

                 plus    $20.00 membership fee

        *OPTIONAL        $70 Non-duty levy

        (Health Care Card Concession rate: 50% discount)

TOTAL ENCLOSED
(Please make cheques payable to Bayside Toy Library Inc.)

Please Note: Members are asked to note the following conditions of membership, as prescribed in the
rules of the Bayside Toy Library: “Members resigning their membership of the Bayside Toy Library are
requested to inform the secretary in writing, giving one month’s notice.”


DECLARATION
        I wish to apply for membership of Bayside Toy Library Inc. for 2012 and agree to comply
        with the rules of operation.



Signature                                                                  Date:




Please Return:           Membership Application Form
                         Subscription Fees

TO: Frank Hajncl
    Bayside Toy Library Co-Ordinator
    PO Box 2
    Hampton Victoria 3188

        Phone: 9598 5253 or 0447 985 221

COMMITTEE USE ONLY:


Receipt Number           ________________                   Amount Paid:

Please initial and date below when form has been processed.

Membership Officer:               ______________________                   (date)____________________

								
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