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THE AQUARIUM SOCIETY OF VICTORIA INC

MEMBERSHIP FORM

NAME ..........................................................	ADDRESS .........................................................
OCCUPATION ..............................................	...........................................................................
PHONE NUMBER ............................................	POSTCODE ........................................................

I hereby apply for Membership TYPE .............In the ASOV



I enclose herewith the sum of $....................in payment of years fees



SIGNED...............................





OFFICE USE ONLY




AMT REC $..........................


APPROVED...........................


TREASURER...........................


SECRETARY...........................