Scrabble Queensland Membership

1st July 2015 - 30th June 2016

First Name………………………………………. Surname……………………………................

Address……………………………………………………………………………………………...

Suburb/Town………………………………………………………… Post Code…………………

Phone No (H)………………………………… (Mob)………………………………………….

Email ………………………………………………………………………………………………..

How do you wish to receive your ATB? Printed only….. Email only….. Both….. (Tick 1)

Membership fees Club members: Single $15, Family $20, Unaffiliated: Single $18*, Family $20

*Unaffiliated single members receiving email ATBs only: $15

Club………………………………. Amt Encl. $.................................. Cheques Payable to A.S.P.A.Q.

The quarterly magazine will be sent to the club you nominate. If you wish the printed magazine to be sent directly to your home address, you must join as unaffiliated.

All details provided are for use by Scrabble Qld and CASPA only.

Rec no:________________________ Date:_____/_______/______

Membership Officer – Jane Brown 24 Maker St, Toowoomba Q 4350. jb.edits@bigpond.net.au