You are on page 1of 1

For use by SPECIFIC Church Officers

WWCC
NAME
NOTICE
NUMBER
Show as
SMITH Allan Thomas

1234567890

SMITH Allan Thomas

TELEPHONE
NUMBER

9999 9999

EMAIL
ADDRESS

RESIDENTIAL
ADDRESS

dogsbody_two@optu
s_big_sky.net.au

Unit 156, 2333 Great Eastern


Highway, South Guildford,
WA

POST
CODE

6990

POSTAL
ADDRESS

PO Box 2333,
Belmont, WA 6110

Please Post/Fax/Email this form to the Conference Office as soon as possible.


Post to Teresa Hort, PO Box 134, Gosnells, WA, 6990
Fax to - (08)9398 5164
Email to - thort@adventist.org.au

EXPIRY
DATE

30/12/09

Y
E
S

N
O

You might also like