Club Membership Dec 31

First name *

Last name *

Address *

Email *

Mobile Phone *

Home Phone (optional)

Emergency Contact Name & Number *

Previous Camera/Photographic Club *If you have been a member of a camera or photographic club in the last 5 years please show the name of the Club. Otherwise just type "none".

Previous Camera Club Grade *If you have been a member of a camera or photographic club during the past 5 years please advise your most recent grading. Otherwise type "N/A"