member form

	Membership Application
	Print this page, fill out and post to: South Australian Thoroughbred Breeders PO Box 2080, South Plympton, South Australia, Australia 5038 or Fax: +61 8 8371 1633
Name:
Address:
Date of Application:
Contact Numbers
Phone:	Mobile:
Fax:
Email:
Cost:	c Annual membership $99.00 (inc. GST)
Payment Details:	Cheque / Money Order / Credit Card
	Visa c Mastercard c
	Card No: cccccccccccccccc
	Expiry: cc / cc
	Cardholders Name (Please Print):
	Cardholders Signature: