Club & Association Membership Application

Club or Association name:
: (Hereinafter referred to as ''The Society'')
Address:: Line 1:
Line 2:
City:
Country:
Australia
State:
Postal Code:
: ''The Society'' understands that Membership of Radio Televisione Italiana (SA) Inc. is valid for the calendar year for which membership is given. The following two (2) persons hereby represent The Society at any Annual and/or Extraordinary Meetings of Radio Televisione Italiana (SA) Inc.:
1 . Representative details:: First Name:
Last Name:
Phone Number:
Mobile:
Email Address:

2. Representative details:: First Name:
Last Name:
Phone Number:
Mobile:
Email Address:
: ''The Society'' will notify Radio Televisione Italiana (SA) Inc. in writing, of any changes to its representatives.
Please select membership tier:: Gold Membership $330Platinum Membership $550
Date:
: Payment - On completing this form, you will be directed to our Make a Payment page ( Online Credit Card Payment ). Membership will be complete once payment is made.

ADDRESS

Unit 3, 215 Port Road, Hindmarsh SA 5007

OFFICE

STUDIO