Graduate Women Wellington
New Zealand Federation of Graduate Women Wellington Branch
PO Box 2006
Wellington 6140
www.graduatewomenwellington.org.nz
MEMBERSHIP SUBSCRIPTION INVOICE
for the year 1 JULY 2015 to 30 JUNE 2016
Due July 2015
Graduate Women Wellington Branch Subscription is
$65 for Graduate members, $60 if paid by 30 September 2015
(Graduate subscriptions include capitation payments totalling $50 approximately to NZFGW and GWI)
Your early payment is greatly appreciated.
Graduate member:
$60.00 ($65.00 after 30 September 2015)
Associate Member:
$35.00 (non-graduate)
Donation:
$ Donation amount
Total payment:
$ Total payment
SURNAME:
Surname
FIRST NAME(S):
First name(s)
TITLE:
Dr, Miss, Ms, Mrs, Prof, Rev, Hon or Dame
ADDRESS:
Street address
Suburb
City
Postcode
EMAIL:
email address
PHONE(S):
Phone number(s), including mobile phone number if available
Additional degree(s), distinctions in the past year:
Additional qualifications
Do you require a membership subscription receipt?
☐
Payment options:
PLEASE DO NOT PAY OVER THE COUNTER AT A WESTPAC BRANCH
Cheques to be made payable to:
NZFGW – Wellington Branch Inc
Post this form with payment to:
Treasurer, Graduate Women Wellington
PO Box 2006, WELLINGTON 6140
Pay by Direct Credit to:
NZFGW – Wellington Branch Inc
Westpac account number: 03 0518 0180237 00
Please enter your name and Sub 15.16 in the reference fields
Email completed form to:
membership@graduatewomenwellington.org.nz
PLEASE LET US KNOW IF YOU DO NOT WANT TO CONTINUE YOUR MEMBERSHIP