Surname______________________________________________

First Name_______________________________Title________

Street Address________________________________________

Suburb______________________________Postcode__________

Phone number_________________Mobile___________________

Email address__________________________________________

Please state whether you would like to receive your magazine by post, or via email____________

Club(s) at which you usually play_____________________

Please enclose cheque/money order for $15 (Adults) or $10 (Juniors) made payable to:

"Australian Scrabble Players Association (Vic) Inc"

and return to:

Dorothy Barraclough
Membership Officer
15 Canterbury Road
Lara Lake VIC 3212