Text Box: BearsCanberra Inc Membership Application /Renewal www.bearscanberra.com GPO Box 1694 Canberra ACT 2601 secretary@bearscanberra.com NEW Membership Application RENEWAL: current card number________ Name: ________________________________________________________ Address: ______________________________________________________ Town/Suburb: ________________State: _________ Postcode: ___________ E-mail: ________________________________________________________ Phone: ______________________ Mobile: ___________________________ Please complete this application and either: include your credit card details below or include your cheque or money order …for $15 per person Credit card c MasterCard c Visa Amount $ Card Number □□□□ □□□□ □□□□ □□□□ Name on card ………………………………………………………………………... Expiry date □□ □□ Signed …………………………………………. For more information please visit our website at www.bearscanberra.com or, email: secretary@bearscanberra.com.au AND send the completed form and payment to The Treasurer BearsCanberra Inc, GPO Box 1694, CANBERRA ACT 2601 A BearsCanberra membership card and receipt will be posted to you as soon as possible. Click arrow to return too previous page