MEMBERSHIP/RENEWAL FORM FOR 2019

Registered Business Name 1 *

Registered Business Name 2

Name of Delegate *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Confirm Email

Your Website / URL

Nature of Business *

ABN: *

Are you a new member or renewing? *

Membership Cost: $90 Annually

Payment can be made via EFT, CASH or CHEQUE
PAYMENTS CAN BE MADE TO:
Southern Flinders Tourism & Tastes
BSB: 105 003
Account No: 113 166 040
Please put your business name as a reference when paying

EMAIL: shirley.dearlove@bigpond.com
POST: PO Box 105, Peterborough SA 5422

Name