Royal Geographical Society of South Australia
Mortlock Wing, State Library of South Australia
North Terrace, Adelaide SA 5000, Australia
Tel/Fax: (08) 8207 7265
Email: admin@rgssa.org.au
Postal address: PO Box 3661, Rundle Mall, Adelaide SA 5000, Australia
New Membership form
Welcome New Member
How did you hear about the RGSSA
Family name
Initials
Given name(s)
Title
Postal address
Street no & name
City/Suburb/Town
State
Post Code
Country
E mail address
Daytime telephone no.
Occupation
Special interests
Membership type required
Ordinary/Overseas ($45)
Family ($55)
Country/Interstate($40)
Concession ($35)
Institutional ($90)
Life ($1,000)
Affiliate ($30)
(Centrelink Pensioner cardholders only)
Student ($20) 1st Year
Amount in Australian Dollars
Payment by Cheque number
(Or) Payment by credit card:
Visa card
Master card
Card No.
Expiry
Name on card
I would like to make a donation to the RGSSA Trust fund and/or to the RGSSA Centenary Library Fund (All contributions of $2.00 and over are Tax deductible-receipt will be sent to you)
RGSSA Inc Trust Fund
$100
$50
$25
Other
RGSSA Inc Centenary Library Fund
$100
$50
$25
Other
Total amount in Australian Dollars
Signature
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Date
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