Membership Application Form - Electoral Reform Society of SA

* I wish to remain on the mailing list. Yes/No

* I apply for/renew membership of the Electoral Reform Society of South Australia from 1st October to 30th September, and enclose $15.00, or $10.00 for pensioners or full time students, as the Annual Subscription.

* I apply for Life Membership ($150)

* I enclose a donation of $....................... to the Society.

* I understand that membership also makes me a member of the Proportional Representation Society of Australia, of which the Electoral Reform Society of South Australia is the South Australian Branch.

SIGNED:.................................... DATE: .............. 20.........

Title
Given Names
Surname
Address
Phone:
Fax:
Mobile:
E-mail:
Please print this form and send with payment to:
ERS Secretary
11 Yapinga Street
South Plympton
SA 5038

Cheques etc. can be made payable "Electoral Reform Society of SA"