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CANA Interim Membership |
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Name of Association/Individual: |
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Location of Association: |
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Name of Secretary: |
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Postal Address: |
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Suburb: |
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Post Code: |
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Telephone: |
(H) |
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(W) |
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Facsimilie: |
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Email: |
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We wish to join CANA as: |
A Member Association with full benefits. |
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An Associate Association. |
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A Social Member. |
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(Please tick one box) |
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Signature of Secretary/Official: |
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Date: |
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Please complete and return to: |
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