Membership Application Form ASA Logo
                                                                The Australian Sommeliers Association Inc.

                                Please print form and post to: P.O. Box 1937  North Sydney  NSW  2060

 
                 Family Name:                                                                                                               .

                 Given Names:                                                                                                               .

                 Email:                                                                                                                           .

                 Mailing Address:                                                                                                             .

                                                                                                                                                         .

                 Postcode:                             .

                 Most Reliable Phone:        /                                                .

                 Place of Work:                                                                                                              .

                 Position Held:                                                                                                                .

                 Work Address:                                                                                                              .

                                                                                                                                                        .

                 Postcode:                           .

                 Work Phone:        /                                                  .

                Annual Fee: $ 100.00

               Chq / Money Orders Payable to:  The Australian Sommeliers Assoc Inc.
                                                                    P.O. Box 1937  North Sydney  NSW  2060

               Credit Cards:      [   ]  Visa       [   ]  Bankcard        [   ]  Mastercard
 

                Name :………………………………………….................……...…..

                Card No:  _ _ _ _  _ _ _ _  _ _ _ _  _ _ _ _    Exp Date:  _ _ / _ _
 

                Signature:………………………………………………………………
 
 
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