TAX INVOICE
 ABN: 21 967 569 182

ATASA Membership Application Form

Name: 
School:
Telephone: 

(w)
(h)

Fax:
Email:
School Address:
Home Address:
Type of membership
applied for (please circle):

School - $60.00
 Personal - $40.00

There is no GST associated with membership

 
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I enclose annual membership subscription.

Signature: _________________           Date:    ________

 

Carolyn Johnson
PO Box 1596, Tintinara SA 5266
Ph: 87 572120 (W)
Fax: 87572187
Email: carolyn.johnson@tas.sa.edu.au

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