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Please print off and complete the following form and then post it to us at the address below.
(Printable MS-Word version)

 

I, .........................................................................................................................

of ........................................................................................................................

Tel: .....................................................................................

Fax: ....................................................................................

E-mail: ....................................................................................

Occupation: ........................................................................

desire to become a member of The Lavoisier Group

In the event of my admission as a member, I agree to be bound by the rules of the Association for the time being in force.

Signature of Applicant:....................................................................................  Date:..........................

I, .........................................................................................................................,

a member of The Lavoisier Group, nominate the applicant for membership of the Group.

Signature of Proposer:......................................................................................  Date:..........................

I, ........................................................................................................................,

a member of The Lavoisier Group, second the applicant for membership of the Group.

Signature of Seconder:......................................................................................  Date:..........................

Cheque enclosed for $ ...........................................    (Annual Subs $50)

Please make your cheque payable to 'The Lavoisier Group, Inc'

The Lavoisier Group,
P.O. Box 424 Collins Street West,
MELBOURNE VIC 8007