THE AUSTRALIAN GEMMOLOGIST
SUBSCRIPTION PAYMENT FORM		   Forward completed form with payment to:
 Mr Ian Carter
Finance Distribution
PO Box 373
ALBION BC 
Queensland 4010
Australia

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 Ian Carter:
Phone: (07) 3262 4386 (Australia)
61 7 3262 4386 (International)
Fax: (07) 3262 6316 (Australia)
61 7 3262 6316 (International)
email: austgemfinance@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    Bankcard
                     
     
Name on
credit card:		 ..........................................  
Expiry date: ....../....../......  
     
Signature ..........................................