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                            MIDWINTER DINNER APPLICATION FORM


                                                     Please reply by 12th June 2017


Name: ...........................................................................................................................

Postal Address: .....................................................................................................................

Email Address:.............................................................................................................................

Phone: H:..................................... W:...................................... Mob:...........................................

I will / will not be attending the AGM and Expeditioners' Midwinter Dinner

I forward $                   Payment.        YES/NO

I will bring and pay for ..................... interested guests.       YES/NO
(Please print name of guest/guests for name tags)

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 AGM BUSINESS, NOMINATION OF OFFICE BEARERS.

I nominate the person named for the position/s listed.

President
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Vice President
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Secretary
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Treasurer
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Committee Member
......................................................................................................

Committee Member
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Committee Member
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Committee Member
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Committee Member
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Regional Representative
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Regional Representative
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Regional Representative
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Regional Representative
...............................................................................................

Signature
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Send responses to:

ANARE Club Qld
PO Box 810

Toowong DC QLD 4066

PAYMENT
Please pay by Cheque, Money Order or EFT no later than 16th June 2017


EFT
Bank of Qld.
Account Name: ANARE Club of Qld.
BSB: 124 193
Account No: 2003 3084. 
(Include name as reference)


Cheques or money orders payable to:
ANARE Club Qld



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