Difference between revisions of "Form:Member"

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<tr><td>Suburb:</td><td><input name="Suburb" /></td><td>City:</td><td><input name="City" /></td></tr>
 
<tr><td>Suburb:</td><td><input name="Suburb" /></td><td>City:</td><td><input name="City" /></td></tr>
  
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<tr><td>Post Code:</td><td><input name="PostCode" size="3" /></td><td>Electorate:</td><td><input name="Electorate" /></td></tr>
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<tr><td>State:</td><td><input name="State" size="3" /></td><td>Zip Code:</td><td><input name="Zip" /></td></tr>
  
 
<tr><td colspan="4"><h4>Contact Details</h4></td></tr>
 
<tr><td colspan="4"><h4>Contact Details</h4></td></tr>
  
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<tr><td>Home Phone:</td><td><input name="HmPhone" /></td><td>Fax:</td><td><input name="Fax" /></td></tr>
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<tr><td>Phone:</td><td><input name="Phone" /></td><td>Fax:</td><td><input name="Fax" /></td></tr>
  
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<tr><td>Other Phone:</td><td><input name="WkPhone" /></td><td>Email:</td><td><input name="Email" /></td></tr>
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<tr><td>Web:</td><td><input name="Web" /></td><td>Email:</td><td><input name="Email" /></td></tr>
  
 
<tr><td colspan="4"><h4>Interests</h4></td></tr>
 
<tr><td colspan="4"><h4>Interests</h4></td></tr>
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<tr><td colspan="2"><input type="checkbox" name="Organisation" /> Organisation</td><td colspan="2"><input type="checkbox" name="Web3" /> Web 3.0</td></tr>
 
<tr><td colspan="2"><input type="checkbox" name="Organisation" /> Organisation</td><td colspan="2"><input type="checkbox" name="Web3" /> Web 3.0</td></tr>
  
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<tr><td colspan="2"><input type="checkbox" name="Administration" /> Administration</td><td colspan="2"><input type="checkbox" name="ContentManagement" /> ContentManagement</td></tr>
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<tr><td colspan="2"><input type="checkbox" name="Administration" /> Administration</td><td colspan="2"><input type="checkbox" name="ContentManagement" /> Content management</td></tr>
  
 
<tr><td colspan="2"><input type="checkbox" name="Technology" /> Technology</td><td colspan="2"><input type="checkbox" name="Philosophy" /> Philosophy</td></tr>
 
<tr><td colspan="2"><input type="checkbox" name="Technology" /> Technology</td><td colspan="2"><input type="checkbox" name="Philosophy" /> Philosophy</td></tr>

Latest revision as of 04:34, 22 October 2008

Name

Title:
First Names:    Surname:

Address

Number:Street:
Suburb:City:
State:Zip Code:

Contact Details

Phone:Fax:
Web:Email:

Interests

Organisation Web 3.0
Administration Content management
Technology Philosophy
Spirituality

Administration

Total paid: $       Payment cleared       Cheque No.

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