Date:_______________________

First Name:_____________________________________

Surname:________________________________________

Address:________________________________________

________________________________________

________________________________________ Post Code___________

Country:________________________________________

Phone:(__)__________________

Fax: (__) __________________

Email:______________________

Areas of interest (eg. Beads, Jewellery, Minatures, Dolls etc.)

_____________________________________________________________________

Please tick if you work in polymer clay professionally:

____________ Part Time ___________ Full Time

I enclose a cheque for NZ$____________. Please make cheque payable to - New Zealand Polymer Clay Guild

Credit Card Details: Mastercard__________ Visa__________

Cardholders No:______________________________________

Cardholders Name:____________________________________

Expiry Date: ____________________________________

Please post to:

• N.Z.P.C.G.
• 8 Cherry Place
• Casebrook
• Christchurch 8005
• NEW ZEALAND
• Ph: +64-3-359 2989
• FAX: +64-3-359-6394