Branch Affiliation Application Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" height=150 BGCOLOR="#006699" TEXT="#080000"> <div> <FONT SIZE="6" COLOR="#FFFFFF" FACE="Arial" ><B>T.I.S.I. (NZ) Sangam</B></FONT><FONT SIZE="1" COLOR="#FFFFCC" FACE="Arial" ><B>     |  </B></FONT><FONT SIZE="4" COLOR="#FFFFCC" FACE="Arial" ><B>   </B></FONT><A HREF="index.htm" TARGET="_top" TITLE="T.I.S.I. (NZ) Sangam"><U><B>Home Page</B></U></A><B>    </B><A HREF="id4.htm" TARGET="_top" TITLE="Documents Newsletters"><U><B>Back to Documents & Newsletters</B></U></A></div> <bR> <div> <A HREF="id53.htm" TARGET="_top" TITLE="OnLine Membership Application Form"><U>On-Line Membership Application Form</U></A>   |   <A HREF="id43.htm" TARGET="_top" TITLE="Guidelines for Branches"><U>Guidelines for Branches</U></A>   |   <A HREF="id44.htm" TARGET="_top" TITLE="Past Newsletters"><U>Past Newsletters</U></A>   |   <B>Branch Affiliation Application Form</B>   |   <A HREF="id72.htm" TARGET="_top" TITLE="Hon Justice Jai Ram Reddy Speech Fiji "><U>Hon Justice Jai Ram Reddy - Speech - Fiji 2003</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" height=330 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>Branch Affiliation Application Form</I></div> <bR> <div> <I><B>(Please Print-Out this Form, Complete, and Return it to us by Post or Facsimile.  </B></I></div> <div> <I><B>We encourage the formation of more Branches and Groups)</B></I></div> <bR> <div> <B><U>APPLICATION FOR BRANCH AFFILIATION</U></B></div> <bR> <div> BRANCH NAME : ___________________________________________________________</div> <bR> <div> ADDRESS : _______________________________________________________________</div> <bR> <div> TELEPHONE NO. : _______________________________ FAX NO. : __________________</div> <bR> <div> e-MAIL ADDRESS : _________________________________________________________</div> <bR> <div> WEB PAGE ADDRESS (if any) : _______________________________________________</div> <bR> <div> <U>OFFICIALS </U>(Please List where applicable) :</div> <bR> <div> PRESIDENT : _______________________________________ PHONE NO. : ____________</div> <bR> <div> VICE-PRES : _______________________________________ PHONE NO. : ____________</div> <bR> <div>                         _______________________________________ PHONE NO. : ____________</div> <bR> <div>                        ________________________________________ PHONE NO. : ____________</div> <bR> <div> SECRETARY : ______________________________________ PHONE NO. : ____________</div> <bR> <div> ASST. SECT : _______________________________________ PHONE NO. : ___________</div> <bR> <div> TREASURER : ______________________________________ PHONE NO. : ____________</div> <bR> <div> ASST. TREAS :______________________________________ PHONE NO. : ____________</div> <bR> <div> COMMITTEE : _______________________________________ PHONE NO. : ___________</div> <bR> <div> COMMITTEE : _______________________________________ PHONE NO. : ___________</div> <bR> <div> COMMITTEE : _______________________________________ PHONE NO. : ___________</div> <bR> <div> OTHER :___ _________________________________________ PHONE NO. :____________</div> <bR> <div> (Continue on another Page if needed)</div> <bR> <div> ACTIVITIES (List Activities that the Branch carries out, if any) : __________________________</div> <bR> <div> __________________________________________________________________________</div> <bR> <div> __________________________________________________________________________</div> <bR> <div> OTHER INFORMATION : ______________________________________________________</div> <bR> <div> Signed by : ____________________________________   DATED :                 /             /</div> <bR> </td> </tr></table></body>