Name:

Address:                                                                                                  State:                       Post Code:

Phone:

Email:

Signature of Applicant:                                                                                                           Date:

If approved for membership I agree to be bound by the Constitution of the Photo Arts Club and the Articles and By-laws of the South Tweed Sports Club.

I am a Member of the South Tweed Sports Club.  Membership Number:

Photo Arts Club Membership Paid on:

                                                 Approval

Treasurer:                                           President: