Nutrition in Schools
Advisory Service

MEMBERSHIP APPLICATION FORM

Name: ______________________________________

Position: ____________________________________

Organisation: _________________________________

Website Address: _____________________________

Address: _____________________________________

______________________________ Post code: _____

Phone:____________________ Fax: _______________

Email: work/home (Please circle):

_____________________________________________

Membership is $55 per year 
(1 March 2005 - February 2006)
(includes GST)

Enclosed is $ _______________
(cheque or money order made payable to “Nutrition Australia”)
Or Please debit my _Bankcard _MasterCard _Visa
Card Number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Expiry Date: _________ Name on Card: _______________

Signature: ______________________

Return this page with payment to:

Nutrition Australia
6/100 Campbell St
Bowen Hills 4006
Australia
Ph: 07-3257-4393 Fax: 07-3876-2254

Do you want information notices and newsletters emailed to you or sent through the post? Email/Post (Please Circle)

When is the tuckshop open?
Monday        Tuesday          Wednesday       Thursday      Friday

When do you serve food?
 Before School         Morning Tea       Lunch       Afternoon Tea

Would you be willing to write a tuckshop tip (no more than fifty words) or tuckshop story (no more than 150 words) Yes/No

*** Send in your tuckshop menu for assessment to be eligible for a Pyramid Award.***