Join Apace

Friend of APACE WA

The APPROPRIATE TECHNOLOGY DEVELOPMENT GROUP

APPLICATION for MEMBERSHIP

Name:

Address:

Email:

Phone (h):

Phone (w) :

Type:

$20 (waged)

$10 (concession)

Payment Details:

Direct credits can be paid to:

Appropr Techn Dev Grp @ Bendigo Bank Ltd

BSB 633 000 Account No 127866200

or by:

Credit Card

Cheque

Cash

Please phone through your credit card details

You may have special skills and interests that you might like to share with Apace. If so, please complete the following section.

Skills and interests:

Please return this form and your membership payment to:

Apace WA (Inc) Winter House, 1 Johannah Street, North Fremantle 6159

Ph: 08 9336 1262 Fax: 08 9430 5729 Email: admin@apacewa.org.au