AUSTRALIAN ASSOCIATION OF STOMAL THERAPY NURSES INC. ABN 16 072 891 322 Journal Subscription Application Form / Invoice _________________________________________________________Renewal due by 31 st December each year The Journal of STOMAL THERAPY AUSTRALIA Published quarterly: March, June, September, December Application Details NAME or INSTITUTION Please insert delivery details here Surname or Institution First Name or Attention Address Address Address Suburb State SIGNATURE Journal Subscription Fee Australia & New Zealand Overseas Post Code Country DATED (GST not included) Send to: AUD 90 AUD 110 Please tick here if you require a receipt. AASTN M/ship Coordinator Robyn Simcock PO Box 153 FLOREAT WA 6014 PAYMENT OPTIONS EFT Banking: A/c Name: AASTN Bank: CBA Fortitude Valley QLD BSB: 064-002 A/c#: 1013 0412 (Please ensure surname & MID (below) is included in your payment description) Cheque /M-Order Credit Card # Please make payable in AUD to “Australian Association of Stomal Therapy Nurses Inc.” _______ - _______ - _______ - _______ Office Use MID ______ Rec’d ____/____/____ Cardholder's Name____________________________________________________ Signature _____________________________________ Expiry Date ____/____ Rec # ____________ Amt$ _______ Access____/____