JOIN

Print out this page, complete your details and post the completed page with your payment to the address below. Please pay by cheque or by electronic deposit to our bank account - email the Membership Officer on the address on the CONTACTS page for online banking account details - be sure to include your name in the reference to appear on our statement. If paying by bank transfer, please be sure to also complete and forward the short form below.

Cash payments can not be accepted.

The Membership Officer,
Alliance Francaise de la Cote de Saphir,
P.O. Box 3,
MERIMBULA 2548

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Alliance Francaise de la Cote de Saphir

Membership Application

NAME(S)

E-MAIL

ADDRESS

PHONE

SUBSCRIPTION (Please circle one)
FAMILY $40
SINGLE $ 25
SCHOOL $ 25

Our monthly newsletter, LA MOUETTE will be sent by email - please advise if this is not possible (ie if you have no email address).

Merci!