Member 1 Name *

First Name

Last Name

member 2 name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What activities are you interested in?

Radio players

Art appreciation

Gardening group

Bolivia

Book discussion

Bushwalking

Caravan group

Choir

Computer group

Computer lessons

Cycling

Five Hundred (cards)

Four-wheel drive

Golf – 9 and 18 holes

Internet lessons

Orchestra

Photography

Pleasure fishing

Par 3 golf

Snooker / 8 ball

Social group

Table tennis

Tap dancing and variety

Tennis

Train the brain

Weekly walkers

Do you wish to be contacted by a representative of the group? *

Yes

No