Northern Suburbs Bonsai Club

Name:

 

Address:

 

Suburb:                                                             Postcode:

 

Contact Numbers: (Hm)                                                     (Mob)

 

Email address:

 

Receive newsletter by email?   Yes / No

 

Fees:

Once off badge fee:   $5

One year's Single Membership:  $30                      Family Membership (2 at the same address) $37.50

 

Total paid: $                                                                  Date Paid:         /           / 20