
Please give us your details:
Surname: .............................................................................................................
Given Names: .....................................................................................................
Male / Female: ...........................
Age: .......................... Date of Birth: .........................................
Address: ............................................................................................................
............................................................................................................................
Town/City: .........................................................................................................
State: ..................................................... Post Code: ........................
Send Applications to:
PSSM Mailbox
Club
Second Floor, Trinity Arcade
671 Hay Street Mall
PERTH WA 6000
Tel (08) 9321 6706
or for Tasmania and Victoria residents:
PSSM Mailbox
Club
56 Ashbolt Crescent
LUTANA TAS 7009