FRENCH AUSTRALIAN ASSOCIATION 

OF QUEENSLAND (Inc.)

 P.O. Box 416 – INALA – QLD 4077

                     APPLICATION FOR MEMBERSHIP 

Year 2010

Names and surnames in block letters please

Mr__________________________________________________________________

Mrs_________________________________________________________________

Miss_________________________________________________________________

Address______________________________________________________________

Suburb __________________________                         Post code __________________

Phone :________________           Fax : _____________ email : ___________________

Nationality __________________________Occupation_________________________

Would you like to receive the newsletter by e-mail?     Yes p                       No p

Names and dates of birth of children if under 12 year old

Hereby make application for membership of French Australian Association of QLD (Inc.) and enclose:

Ø      $20 per family (annual fee) - $15 per single (annual fee)

 Business card advertising member $40 (Annual fee)

This application is nominated by: _______________Date_________ Signature___________

Date________________ Applicant Signature ______________________

S'il vous plait. Imprimer ce formulaire, remplir et envoyer à l’adresse ci-dessus avec le montant de la cotisation, merci. 

Please print clearly, and mail it with membership fee to the address above.