KLAVIER
Music Association Inc.
PO Box 6167
O'CONNOR ACT 2602

Application for membership



Title (Dr Mr Mrs Ms etc): _____________________________________________________________
Given name: _____________________________________________________________
Family name: _____________________________________________________________
Postal address: _____________________________________________________________
Phone: (H)____________________(W)____________________
Mobile phone: _______________________
Email address: _____________________________________________________________

Would you like to play at Klavier's Sunday Socials? Yes/No

I enclose $________ as my subscription to Klavier Music Association Inc.

Signed __________________________________

Date __________________________________