The Avicultural Society of
Southern Tasmania inc.

(Please Print)

First Name..........................................................

Surname.............................................................

Address................................................................

.......................................................................

State.............................................Postcode ............

Phone .......... ..................................

If this is a family Membership state given names below.

......................./......................../......................

......................./......................../......................

Please list Birds that you are interested in 

.......................................................................

.......................................................................

Signature......................................Date...../..../.........

Subscription Rates,
Single/Family.....$25.00
Pensioner/Family..$20.00        Pension No.  ..........................
Junior............$10.00

Please fill in this application and send it with payment to,
 
The Membership Officer
Avicultural Society of Southern Tasmania inc.
PO.Box 714 
Moonah
TAS  7009 
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       Proposed By.....................................................

       Presented to Committee meeting....../....../..........

       Signed by............................................President