Sunflower Club Membership Form
First Name
Last Name
Organisation
Mailing Address
Contact No.
Email
Membership Category
Platinum $2,400
Gold $1,200
Silver $600
Bronze $300
Crystal $130
Please deduct the following amount from my card
$AUD2,400
$AUD1,200
$AUD600
$AUD300
$AUD150
Card
Bankcard
Mastercard
Visa
Cardholder's Name
Card Number
Expiry
Today's Date
Total
Receipt Required?
I understand that I can cancel this arrangement at any time by writing to the Schizophrenia Fellowship of NSW
SFNSW Inc...Locked Bag 5014 Gladesville NSW 1675...ph: 02 9879 2600...fax: 02 9879 2699...Email: admin@sfnsw.org.au
