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					       New-member membership form for year ending 1 July 2009

Family name:_____________________            Given name(s):___________________________

Spouse or partner's name (and lastname):___________________________________________
Mailing address:       ___________________________________________________________
_________________________________________________________ Postcode __________
Phone numbers:         Home ___________________
                       Work ___________________Mobile_______________________
Either: Email address(es) (our membership files cater for two or more email addresses per family):
       __________________________________________________________________________
Or:      Tick this box if you are unable to receive club information and updates via email


(Optional) Children's names:                                 Dates of birth (for organizing Santa's gifts etc):
_____________________________________                        ____________________
_____________________________________                        ____________________
_____________________________________                        ____________________
_____________________________________                        ____________________
(Optional) Citizenship(s):
       Australian                    Canadian                       Other(s)                      
(Optional) Canadian cities and/or regions with which you have a connection / connections:


(Optional) A short backgrounder on yourself, and/or ideas and/or suggestions for ACA in SA:




___________________________________________________________________________________

Annual fees:    Single $20. Family $30. – includes spouse/partner and children under 18
                                 Auspost your completed form with payment to:
Either:                          Australia Canada Assocation, PO Box 8282, Station Arcade, SA, 5000.
                                 Cheques & money orders payable to the Australia Canada Association

                                 Email all of the above information to info@canadainsa.org.au,
Or:                              then e-transfer your payment to:
                                 BSB 105 159 account 016349240, reference "Familyname-mfee"

				
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