THE AUSTRALIAN GEMMOLOGIST
SUBSCRIPTION PAYMENT FORM		  

Forward completed form with payment to:

The Australian Gemmologist/Subscription

PO Box 1587

East Victoria Park

WA 6981

Australia

Fax: (08) 9361 1306 (Australia)

+61 8 9361 1306 (International)
email: austgem@gem.org.au

All Payments in AUSTRALIAN DOLLARS
(Please print this form before completing and mailing. NOTE: When printing this form, click the cursor within the form boundary to select this page, before choosing print)

  
If you have any further queries please
contact Francine Payette:
Phone: (08) 9361 1306 (Australia)
+61 8 9361 1306 (International)
email: austgem@gem.org.au
Prof   Dr   Mr   Mrs   Miss   Ms

Please print clearly to avoid delays

Name: ..................................................................................
Address: ..................................................................................
  ..................................................................................
  ..................................................................................
   
email: ..................................................................................
Telephone: ..............................
I enclose cheque/money order/credit card for $A ...........................
 Mastercard    Visa  
                     
     
Name on
credit card:		 ..........................................  
Expiry date: ....../....../......  
     
Signature ..........................................