VICTORIAN TELEPHONE & SMART CARD COLLECTORS CLUB INC

Membership Application Form.

NEW OR RENEWAL

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country

Occupation

Age Phone

Your Email Address

Type of Membership
PAYMENT FOR CLUB MEMBERSHIP IS $10-00 AUSTRALIAN AND CAN BE ONLY BY CREDIT CARD USING THIS FORM. CLUB MEMBERSHIP IS FROM 1 July 2008 to 30 June 2009
Type of Card Name on Card
Credit Card Number Expire Date Your Credit Card Statement will show a deduction of $10-00 AUD - payment to John Thomas.

Are you a Member of any other Phonecard Club -
Name of Clubs

Your Collecting Interests - Countries, Themes.
Countries

Themes

When you press the Submit button, the info will be forwarded to the club and you will be automatically returned to the Club's main page.