Printable SOFAR Membership form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=65 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="21a8dfe1esnpes.jpg"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>SOFAR</B></FONT><B>     </B><B>|</B><B>     </B><A HREF="index.htm" TARGET="_top" TITLE="SOFAR"><U><B>home</B></U></A></div> <div> <A HREF="id27.htm" TARGET="_top" TITLE="SOFAR members discounts benefits "><U>SOFAR members discounts & benefits </U></A>   |   <B>Printable SOFAR Membership form</B></div> <div> </div> </td> </tr><tr> <td valign="top" height=415 BGCOLOR="#FFFFFF" TEXT="#080000" bgproperties="fixed" background="21a8dfc3.jpg"> <div> <I>Printable SOFAR Membership form</I></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="782" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP ROWSPAN=5 COLSPAN=2 HEIGHT= 35 WIDTH="233"><div> <B><IMG SRC="3558d860.png" border=0 width="141" height="134" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> </tD> <tD VALIGN=TOP COLSPAN=7 WIDTH="522"><div> <B>S.O.F.A.R</B></div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=7 WIDTH="522"><div> Society of Frogs and Reptile Inc.</div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=7 WIDTH="522"><div> P.O Box 30 JESMOND  NSW  2299</div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=7 WIDTH="522"><div> FY  11 / 12</div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=7 WIDTH="522"><div> Membership New / Renewal</div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=9 HEIGHT= 21 ><NOBR><div> NAME:<FONT SIZE="1" COLOR="#000000" FACE="Arial" > </FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" >Mr/Mrs/Miss/Ms/Dr</FONT>…………………..……………………………………………………………………….</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=9 HEIGHT= 18 ><NOBR><div> ADDRESS: ……………………………………………………………………………………………………..</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=5 HEIGHT= 18 ><NOBR><div> TOWN / SUBURB: ……………………….</div> </NOBR></tD> <tD VALIGN=TOP COLSPAN=3 WIDTH="166"><div> STATE: …………</div> </tD> <tD VALIGN=TOP WIDTH="216"><div> POSTCODE: …………</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 18 WIDTH="225"><div> PHONE: …………………</div> </tD> <tD VALIGN=TOP COLSPAN=5><NOBR><div> MOBILE: ………………………</div> </NOBR></tD> <tD VALIGN=TOP COLSPAN=3><NOBR><div> EMAIL: ……….……………………..</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=4 HEIGHT= 18 ><NOBR><div> DATE: ………………………………</div> </NOBR></tD> <tD VALIGN=TOP COLSPAN=5 WIDTH="448"><div> SIGNATURE: ……………………………...</div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=9 HEIGHT= 18 WIDTH="756"><div> Other people covered ON FAMILY MEMBERSHIP (Conditions Apply):</div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=3 HEIGHT= 18 WIDTH="270"><div> 1.</div> </tD> <tD VALIGN=TOP COLSPAN=4 WIDTH="255"><div> 2.</div> </tD> <tD VALIGN=TOP COLSPAN=2 WIDTH="229"><div> 3.</div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=3 HEIGHT= 19 WIDTH="270"><div> 4.</div> </tD> <tD VALIGN=TOP COLSPAN=4 WIDTH="255"><div> 5.</div> </tD> <tD VALIGN=TOP COLSPAN=2 WIDTH="229"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="229" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=5 HEIGHT= 18 WIDTH="372"><div>      Family  Membership <FONT SIZE="1" COLOR="#000000" FACE="Arial" >(2 adults + 4 children)</FONT></div> </tD> <tD VALIGN=TOP COLSPAN=4 WIDTH="383"><div> $30.00 <FONT SIZE="1" COLOR="#000000" FACE="Arial" >AUD</FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=5 HEIGHT= 18 WIDTH="372"><div>      Single Membership</div> </tD> <tD VALIGN=TOP COLSPAN=4 WIDTH="383"><div> $15.00 <FONT SIZE="1" COLOR="#000000" FACE="Arial" >AUD</FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=5 HEIGHT= 41 ><NOBR><div>      Group / Business / Interstate <FONT SIZE="1" COLOR="#000000" FACE="Arial" >(Please circle)</FONT></div> <div>                       (receive newsletter only)</div> </NOBR></tD> <tD VALIGN=TOP COLSPAN=4 WIDTH="383"><div> $10.00 <FONT SIZE="1" COLOR="#000000" FACE="Arial" >AUD</FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=5 HEIGHT= 18 WIDTH="372"><div>      Donation to SOFAR</div> </tD> <tD VALIGN=TOP COLSPAN=4 WIDTH="383"><div> $ ……………… <FONT SIZE="1" COLOR="#000000" FACE="Arial" >AUD</FONT>      </div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=5 HEIGHT= 18 WIDTH="372"><div>       Total of payment:</div> </tD> <tD VALIGN=TOP COLSPAN=4 WIDTH="383"><div> $…………………….</div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=9 HEIGHT= 500 ><NOBR><bR> <div> Would you like to receive reminders and updates about SOFAR via email, if this option is available? <FONT SIZE="1" COLOR="#000000" FACE="Arial" >(please circle)</FONT>  </div> <div>                                                    Yes                        No</div> <bR> <div> Would you like your newsletter emailed <FONT SIZE="3" COLOR="#000000" FACE="Arial" >(please circle)    </FONT>Yes     No     or sent via post      Yes       No </div> <bR> <div> Optional</div> <div> Amphibian / Reptile keepers licence number: …………………………….</div> <div> Type of frogs / reptiles you keep: ……………………………………………………………………………</div> <div> SOFAR is invited to take their frogs and reptiles to various local events, would you be interested in bringing </div> <div> your frogs or reptiles. <FONT SIZE="1" COLOR="#000000" FACE="Arial" >(please circle)</FONT>       Yes               No</div> <bR> <div> <B>Please Note:</B></div> <div>  </div> <div> <IMG BORDER="0" SRC="Wing0a7300d800f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Membership form must be accompanied with payment. </div> <div> <IMG BORDER="0" SRC="Wing0a7300d800f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">All cheques are made payable to The Society of Frogs And Reptiles Inc.</div> <div> <IMG BORDER="0" SRC="Wing0a7300d800f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">All memberships include the quarterly SOFAR magazine.</div> <div> <IMG BORDER="0" SRC="Wing0a7300d800f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Prices are subject to change without prior notice.</div> <div> <IMG BORDER="0" SRC="Wing0a7300d800f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Membership year is 1 July - 30 June each year.</div> <div> <IMG BORDER="0" SRC="Wing0a7300d800f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Family membership includes two (2) adults and up to four (4) children 17 years and under.</div> <div> <IMG BORDER="0" SRC="Wing0a7300d800f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">This form and prices are effective as of May 2007.</div> <bR> <DIV ALIGN="LEFT"></DIV> <div> ______________________________________________________________________________________</div> <bR> <div> <I><B>Office use only</B></I></div> <bR> <div> Form of payment:: Cheque / Money order / Cash          Date payment received:_ _ _ _ _ _ _ _       Receipt Number:_ _ _ _ _ _ _ _</div> <bR> <div> Membership No: _ _ _ _ _ _ _ _      Card: Given / Send       Date: _ _ _ _ _ _ _ _ _ _          Poster given: Yes / No<FONT SIZE="3" COLOR="#000000" FACE="Arial" >                                     </FONT></div> </NOBR></tD> </tR> </TABLE></div> <bR> </td> </tr></table></body>