Form 43

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Club Information

for 2009 -2010 Directory

Please fill all fields or put na.
This information should be completed by 1st April 2009
Helpful hint - Use the "Tab" key to move to the next field.

Name of submitter:

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Email :

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Club Information

Select your club:

Incorporated?
yes No

State:

District A:

Year of Charter:

No of members:

Day of meeting
eg - Third Thursday:

Time of meeting:

Place of meeting:

Date of charter:

<< Please leave blank

Please enter details for President
First Name:		Last Name:
Partner:		Address:
Suburb:		Postcode:
Phone number format: nn nnnn nnnn Mobile format: nnnn nnn nnn
Phone:		Fax:
Email Address		Mobile:

Please enter details for Secretary
First Name:		Last Name:
Partner:		Street Address:
Suburb:		Postcode:
Phone number format: nn nnnn nnnn Mobile format: nnnn nnn nnn
Phone:		Fax:
Email Address		Mobile:

Please enter details for Treasurer
First Name:		Last Name:
Partner:		Street Address:
Suburb:		Postcode:
Phone number format: nn nnnn nnnn Mobile format: nnnn nnn nnn
Phone:		Fax:
Email Address		Mobile:

Please enter details for Club Correspondent
First Name:		Last Name:
Partner:		Street Address:
Suburb:		Postcode:
Phone number format: nn nnnn nnnn Mobile format: nnnn nnn nnn
Phone:		Fax:
Email Address		Mobile:

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Last modified: 15/12/2008 2:10:16 PM