[Please print & complete form & forward to address below]
NAME: Surname First Name Middle Name
Title .(Mr, Mrs, Ms) Sex .(Male/Female) Date Of Birth ..
Q Squash Affiliation number (if known)
(If not affiliated own insurance should be taken out)
Phone: (Home) ..(Work)
(Mobile) (E-mail) ..
Club Grade Position ..
Do you wish to receive your newsletter via email Yes No
I, the undersigned, hereby make application for admission as a Member of the Queensland
Masters Squash Association Inc.
If accepted, I agree to abide by the rules and regulations set down by the Association.
Signature ..Date .
PLEASE FORWARD THIS APPLICATION TOGETHER WITH PAYMENT OF $25.00 TO:
Mr Peter Knauth EFT DETAILS
Treasurer, QMSA BSB: 124074
37 Osanna Street ACC. NUMBER 10487588
DAISY HILL QLD 4127 USE NAME AS REFERENCE
PLEASE MAKE CHEQUES PAYABLE TO :-
QUEENSLAND MASTERS SQUASH ASSOCIATION INC.