|
AMRA INC. MEMBERSHIP APPLICATION FORM |
|
| SURNAME | FIRST NAME |
| PREFERRED NAME | MIDDLE NAME |
| SPOUSE'S NAME | |
| FAMILY MEMBER | |
| FAMILY MEMBER | |
| ADDRESS- STREET & NUMBER | |
| TOWN/SUBURB | POST CODE |
| POSTAL ADDRESS | POST COD |
| E-MAIL ADDRESS | |
| PHONE NUMBER AH | PHONE NUMBER BH |
| FAX NUMBER | |
| PRINCIPAL SCALE | GAUGE mm |
| PROTOTYPE | |
| MEMBERSHIP CATEGORY | IF JUNIOR AGE |
| PARENTAL CONSENT (If under 16) | |
| APPLICATION DATE | |