APPLICATION FOR MEMBERSHIP........... Number............

LAST NAME: .................................................	FIRST NAME: ........................

POSTAL ADDRESS: ....................................................................................

STATE............... POST/ZIP CODE: .................COUNTRY...........................


MEMBERSHIP CATEGORY:   (Prices Quoted are in Australian Dollars)

	NEW MEMBER				RENEWING MEMBER

	(     )	$20 Senior				(    )    $15 Senior

	(     )	$10 Junior under 16 years 		(    )    $8  Junior

	(     )	$15 Associate non-attending		(    )    $12 Associate

	(     )	$25 Family				(    )    $20 Family

	(     )	$30 International			(    ) 	  $25 International


Memberships are due for renewal on 1st  July of each year. Any member failing to renew
by two or more months ceases to enjoy the benefits of membership.


DATE OF BIRTH: .........................................  (Junior members only)


MAIN AREAS OF INTEREST:

	    Australian	 	 International	      Thematic (Specify)

Mint	    (    )               (    )               (    ) ............................

Used        (    )               (    )               (    ) ............................

Packs       (    )               (    )               (    ) ............................


HOW DID YOU LEARN ABOUT THE MELBOURNE PHONECARD CLUB INC?

.........................................................


DECLARATION:  I agree, on approval of membership, to abide by the rules and
regulations in place under the Constitution of The Melbourne Phonecard Club Inc.


APPLICANT’S SIGNATURE: ......................................... DATE: ...................