CANA – Membership Form

 

CANA Interim
Membership

Name of Association/Individual:

 ………………………………………………………….

Location of Association:

 ………………………………………………………….

Name of Secretary:

 ………………………………………………………….

Postal Address:

 ………………………………………………………….

Suburb:

   ………………………..

  Post Code:

   ………….

Telephone:

   (H)   …………………………………
  (W)   …………………………………

Facsimilie:

 ………………………………………………………….

Email:

 ………………………………………………………….

We wish to join CANA as:

  A Member Association with full benefits.
 An Associate Association.
 A Social Member.

(Please tick one box)

Signature of Secretary/Official:

 ………………………………………………………….

Date:

 ………………………………………………………….

Please complete and return to:
Mrs.
Marilyn Hindmarch
28 Munbilla Dr, Kelso, Townsville Qld 4815
Australia.

Phone: (07) 4774 0669
Mobile: 0438 740 669

Email: cchgowa@gmail.com