PJCOA - Membership Application Form

THE PUB JUG COLLECTORS
OF AUSTRALIA INC.
22 MITCHELL AVENUE,
BORONIA 3155, VIC. AUSTRALIA

MEMBERSHIP APPLICATION FORM

SURNAME.............................................................................................................

CHRISTIAN NAME................................ SPOUSE'S..........................................

ADDRESS.............................................................................................................

STATE.......................................... POST CODE.................................................

PHONE No............................................... FAX No..............................................

E-MAIL...................................................................................................................

I understand the membership fees for "The Pub Jug Collectors of Australia."
are as follows;

Joining Fee.	Au. $10.00.
Membership Fee.	Au. $17.00. Per Year.
PJCOA 5^th Annaversary Jug.	Au. $25.00 (Order Now only 6 Jugs left)
Pack & Post.	Au. $15.00. (Australia) Au. $25.00. (outside Australia)

Please make cheques / money orders payable to;
Pub Jug Collectors of Australia.

Each Member will be issued a membership number, and that number will remain
with that member for ever. (No duplicate numbers will be issued.)

My Interests in collecting are as follows:-

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