Please COMPLETE THIS FORM and POST it with your payment to:
$uparating$, PO Box 1005, Ashmore City, Qld Australia 4214

$uparating$ - Membership Application

Firstname	__________________________		Surname	__________________________
Street Address	____________________________________________________________________________
City	__________________________		State	__________________________
Post Code	__________________________		Country	__________________________
Phone No.	__________________________		Fax No	__________________________
E-mail	__________________________
Total Deposit $:	__________________________ (note; minimum deposit of $12.50 applies)
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