ASSH Membership Form

Membership Form

Australian Society for Sports History

Please print out this form and return with payment to the address below
1. Select Membership type

Individual Member	$50
Concession rate*	$25
Institutional Member	$100
Life Member (Australia/New Zealand)	$500
Life Member (Overseas)	$750

2. Name

3. Address (this is your delivery address)

4. Phone/Fax

5. Email

Please make cheques payable to "ASSH"
Please charge my Bankcard/MasterCard/VISA account

6. Amount

7. Expiry date

7. Credit card number

8. Signature

9. Cardholder name & address

All categories must be filled in for this to be a legal transaction.

Please note that ASSH is not registered to collect the GST. Our ABN is: 18003835298

Please forward membership form with payment to:

Gary Osmond
ASSH Membership & Claims Officer
School of Human Movement Studies
The University of Queensland QLD 4072
AUSTRALIA

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