PORT ADELAIDE SUPPORTERS CLUB
Post Office Box 2356, Port Adelaide SA  5015

JOIN NO.1 MEMBER BRUCE ABERNETHY AND BECOME A MEMBER OF THE
OFFICIAL PORT ADELAIDE SUPPORTERS CLUB IN 2002

APPLICATION FORM

TITLE:              MR        MRS        MS        MISS  

SURNAME: ___________________________________________________________________________

FIRST NAMES: ________________________________________________________________________

HOME ADDRESS: ___________________________________________________  POSTCODE ________

POSTAL ADDRESS __________________________________________________  POSTCODE ________

TEL (H): _________________________________            TEL (W): ________________________________

EMAIL: _______________________________________________________________________

BIRTHDATE: _______________________________________________________

JOINING FEE: $15.00 PER ADULT 
$30.00 PER FAMILY
(2 ADULTS & 2 CHILDREN)		 
$10.00 CONCESSION 
$10.00 STUDENT
OVER 17		 
$5.00 PER CHILD
UNDER 17		 

PAYMENT SHOULD BE MADE IN CASH TO A COMMITTEE MEMBER OR BY CHEQUE / MAIL ORDER TO THE ABOVE POSTAL ADDRESS.

ARE YOU INTERESTED IN INTERSTATE TRAVEL TO POWER GAMES?

YES            NO