Name(s): ……………………………………………………………………………………………………

Postal address: ……………………………………………………………………………………………

E-mail address: ……………………………………………………………………………………………

Telephone: …………………………………………………………………………………………………

Additional Information…………………………………………………………………………………………………

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Tick as appropriate:

…. My/our subscription to Learningguild, paid by cheque, is enclosed.

… My/or subscription to Learningguild has been paid by bank transfer to – BSB: 633 108; Account number: 1622 69245; Account name: Learningguild

… I/we have added a donation of $ ……

Post to Learningguild, 23 Fallon St, Brunswick, Victoria 3056. Please make cheques out to Learningguild.