New Zealand Juggling Association, Inc.

Note: You must complete a paper copy of this form and sign it to validate your membership in the NZJA Inc., before returning it to:

The Editor, Flying Kiwi
NZJA Inc.
PO Box 2238
Wellington, New Zealand

Application to

    join/re-subscribe   (delete as appropriate)

the New Zealand Juggling Association Incorporated (NZJA Inc.)

Fees in NZ dollars (1NZD = approx 0.6USD March 1995)
(includes a 4 issue subscription to The Flying Kiwi)

 ________             Adults  @ $20.00  =    ________________

 ________         Under 16's  @ $15.00  =    ________________

 ________             Family  @ $30.00  =    ________________

 ________   Overseas Address  @ $30.00  =    ________________


I enclose a cheque for the total amount of $ ________________
made payable to :-  New Zealand Juggling Association



Name(s)
_____________________________________________________________

_____________________________________________________________

_____________________________________________________________


Address
_____________________________________________________________

_____________________________________________________________

_____________________________________________________________


Telephone
_____________________________________________________________


I authorise placement of my

    name
    address
    telephone number
    email address

in NZJA publications of membership lists (tick/delete as
appropriate) and I agree to abide by the NZJA Inc. Rules.



Signed  _________________________________________________


Please return this form to:

    The Editor, Flying Kiwi
    NZJA Inc.
    PO Box 2238
    Wellington, New Zealand