Wufoo

Name * First Last
Membership Number
Second Member at same address

If there are two JEMS members at your address, add the name and membership number for the first child in this box.
Second Membership Number at same address

If there are two JEMS members at your address, add the name and membership number of the second child in this box.
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Type of Membership

*

City $80
Country $56
Student/Unemployed $40
JEMS $65
JEMS Country $21
Multiple Membership
2 City Adults $142
1 Adult + 1 Child $127
1 Adult + 2 Children $174
2 Country Adults $94
Membership Fee * $ Dollars . Cents
Date Paid * DD / MM / YYYY
Make EFT payments to

Embroiderers Guild of SA Inc
BSB 105 031 Acc. 143753540
Your Bank Payment Receipt Number *

If you are a city member your Embroiderers' Guild receipt will be placed in the Receipt Box in the Gallery
If you are a country member your receipt will be mailed at the end of the month to your branch Secretary
Do Not Fill This Out

Wufoo Powered