Page 1 of 4
COUNTRY CITY CONTACTS Please write this Form in English if possible the following Off -
line & On - line / e - Commerce, Application Form(s), best printed with
Portrait Page Setup Margins ALL 6 mm ( Millimeters ) & View text size
Smallest, & Edit / Format Font size Regular 1 ( 8 pt )
Travellers' & Singles' International
Networks
for Travel, e-pals or
pen-pals for Travel Dating, Travel Mating,
Adults
cccform.html
3 / 371 Morphett Road,
Oaklands Park, Adelaide, SA 5046, SOUTH AUSTRALIA
Country City Contacts is designed to
allow Travellers / Members in Countries / Cities / Regions & / or Oceanics,
to be able to make contact with others in a similar position, World - Wide. The
Membership / Registration Fee is now compulsory, but the Service is still on a
Self - Help basis & is rendered in Good Faith.
As such, our Contacts Organisation is still
significantly on a Donation basis ; any Financial Assistance that is offered by
individual Members / Registrants & / or Body Corporates, to contribute to a
reasonable share of all operating costs including Web Site & Data Bases
Annual Charges, Designing, & Development ; professional time, advertising,
mail handling, printing &stationery, photocopying, postage, etc., will be
very much appreciated ; in addition to the AUD $ 35 ( Australian Dollars )
Membership / Registration fee, Page 4 of 4, also to be attached.
When your personal details is given to others,
only your first name, initial, phone number ( or nearest Town / Suburb Locality
Post Office Address ), & some particulars are issued. This allows initial
contact to be made and if you feel that you would like further contact, it is
then up to you to provide the caller or addressee with further details. For
those who have no phone or prefer not to use it, contact will always be made by
conventional post ( or e-mail ) using given name, initial, & C/o nearest
Town / Suburb Locality Post Office ( or your Street Address, if you so desire
).
Please edit & post ONLINE OR download,
print, fill - in, & post OFF - LINE ;
WHEN SENDING ANY DETAILS OR ENQUIRIES BY
CONVENTIONAL MAIL, PLEASE ALWAYS INCLUDE A STAMPED SELF ADDRESSED ENVELOPE (
S.S.A.E. ) WHENEVER REQUIRED
STRICTLY PRIVATE & CONFIDENTIAL
INFORMATION
Please fill in as much of your personal details
below, as you feel comfortable with, for your CCC Membership /
Application Form Pages 1 - 3 below ( Registration fee of AUD $ 35 ( Australian
Dollars ) Page 4, also to be attached ) Please
edit & post ONLINE OR download, print, fill - in & post OFF - LINE
; A ll Confirmation(s)
copies ; ON - LINE, post by e - mail to contacts@travellersoz.com.au OR OFF - LINE, post by conventional mail to
C/o Registered Company Office, 3 / 371 Morphett Road, Oaklands Park, ADELAIDE,
SA 5046, AUSTRALIA.
However, the successes of your compatible
Match(es) depend on supplying as much Personal Information as
possible. Remove at any time by
contacting Country City Contacts indicating that you no
longer require the service, or have changed your address or
destination. All cancellations are subject to a
non - Refund, for Administration and Handling costs. Please attach a non -
returnable, dated & signed, recent passport size photo(s), if available or
desired, also.
First / Given Name : Initial :
Last / Surname :
Apartment / Suite / Street Address :
Country / Region / Oceanic : Please select one ( 1 ) if correct
Australasia Europe North
Americas Asia Pacific South
Americas South Africas India
North Africas go to Other
Specifics Other Specifics : State / Province : Post / Zip Code : Internet Country / Code : Please select one ( 1 ) if correct al
Albania dz Algeria as American
Samoa aq Antarctica ar Argentina
au Australia at Austria bh
Bahrain bb Barbados be Belgium
bm Bermuda ba Bosnia & Herzegowina
br Brazil io British Indian Ocean Territory
vi British Virgin Islands bn Brunei
Darussalm bg Bulgaria kh Cambodia
cm Cameroon Islands ca Canada cv
Cape Verde Islands ky Cayman Islands cl
Chile cn China cx Christmas Island
co Colombia ck Cook Islands cr Costa
Rica hr Croatia cy Cyprus
cz Czech Republic ( cs former Czechoslovakia ) dk
Denmark tp East Timor ec Ecuador
eg Egypt sv El Salvador gq
Equatorial Guinea er Eritrea ee
Estonia et Ethiopia fk Falkland
Islands fj Fiji Islands fi Finland
fr France gf French Guiana pf French
Polynesia tf French Southern Territories gm
Gambia ge Georgia de Germany ( New
) gh Ghana gi Gibraltar gr
Greece gl Greenland gd Grenada /
Carricou gu Guam gt Guatemala
gg Guernsey gn Guinea gy
Guyana hn Honduras hk Hong Kong
hu Hungary is Iceland in
India id Indonesia ir Iran
iq Iraq ie Ireland im Isle of
Man is Israel it Italy jm
Jamaica jp Japan je Jersey
jo Jordan ki Kiribati, Gilbert Islands
kw Kuwait la Laos Peoples' Democatic
Republic lv Latvia lb Lebanon
ly Libyan Arab Jamahiriya li Liechtenstein
lt Lithuania lu Luxembourg mo
Macao mk Macedonia mg Madagascar
my Malayia mv Maldives mt
Malta mh Marshall Islands mu
Mauritius mx Mexico fm Micronesia
mc Monaco ms Montserrat ma
Morocco mm Myanmar ( Burma ) nr
Nauru np Nepal nl Netherlands
nc New Caledonia nz New Zealand ni
Nicaragua nf Norfolk Island kp North
Korea no Norway om Oman pk
Pakistan ps Palestine pa Panama
pg Papua New Guinea py Paraguay pe
Peru ph Philippines pn Pitcairn
Island pl Poland pt Portugal
pr Puerto Rico qa Qatar re Reunion (
France ) ro Romania ru Russia ( su former
USSR ) sh Saint Helena lc Saint
Lucia sm San Marino sa Saudi Arabia
yu Serbia & Montenegro ( ex Yugoslavia ) sc
Seychelles sl Sierra Leone sg
Singapore sk Slovakia si Slovenia
so Somalia za South Africa kr South
Korea sb Solomon Islands es Spain
lk Sri Lanka se Sweden ch
Switzerland sz Syrian Arab Republic tw
Taiwan tz Tanzania th Thailand
to Tonga tt Trinidad & Tobago tn
Tunisia tr Turkey ua Ukraine
ae United Arab Emirates uk United Kingdom ( gb Great
Britain ) us United States of America ( U.S.A. )
um United States Minor Outlying Is vi US Virgin
Islands uy Uruguay vu Vanuatu
va Vatican City State ( Holy See ) ve
Venezuela vn Vietnam wg Western Jordan &
Gaza eh Western Sahara ws Western
Samoa zm Zambia zw Zimbabwe
go to Other Specifics Other Specifics
: Ethnicity / Ancestory / Heritage :
Main Language :
Page 2 of 4
E-mail Address(es) : URL or Home Page(s) : Purpose(s) of URL or Home Page(s) :
Toll Free Telephone / Fax ( if any ) : International
Access Code : - Country Code : - Area Code : - Telephone : Fax : Number : Best Time to Ring / Send : pm : or am :
in the event that you do not have a phone /
fax, or wish not to use it : nearest Town /
Suburb Locality Post Office Address : C/o
Post Office Street Address :
Post Office Other Specifics : Post Office, Post / Zip Code :
Education : Occupation : Company : Purpose of Company :
Age Range in Years : Please select one ( 1 ) if correct 18 - 24
years 25 - 29 years 30 - 34 years
35 - 39 years 40 - 44 years 45 - 49
years 50 - 54 years 55 - 59 years
60 - 64 years 65 - 69 years go to
Other Specifics Other Specifics :
Birth Date : Day 01 02
03 04 05
06 07 08
09 10 11
12 13 14
15 16 17
18 19 20
21 22 23
24 25 26
27 28 29
30 31 / Month 01 02
03 04 05
06 07 08
09 10 11
12 / 19 20 Year - Animals / Tong Sing 82 / Dog water +
81 / Rooster metal - 80 / Monkey metal +
79 / Goat earth - 78 / Horse earth +
77 / Snake fire + 76 / Dragon fire +
75 / Rabbit wood - 74 / Tiger wood +
73 / Ox water - 72 / Rat water + 71
/ Pig metal - 70 / Dog metal + 69 / Rooster
earth - 68 / Monkey earth + 67 / Goat fire
- 66 / Horse fire + 65 / Snake wood
- 64 / Dragon wood + 63 / Rabbit water
- 62 / Tiger water + 61 / Ox metal
- 60 / Rat metal + 59 / Pig earth -
58 / Dog earth + 57 / Rooster fire -
56 / Monkey fire + 55 / Goat wood -
54 / Horse wood + 53 / Snake water -
52 / Dragon water - 51 / Rabbit metal -
50 / Tiger metal + 49 / Ox earth -
48 / Rat earth + 47 / Pig fire - 46
/ Dog fire + 45 / Rooster wood - 44 / Monkey
wood + 43 / Goat water - 42 / Horse water
+ 41 / Snake metal - 40 / Dragon metal
+ go to Other Specifics Other
Specifics : Star / Animal Sign : Please select one ( 1 ) Year - Month Animals / Earthly
Branches Scorpio ( Oct 24 - Nov 22 ) / Pig ( Boar ) /
Hai Sagittarius (Nov 23 - Dec 21) / Rat / Tzu
Capricorn (Dec 22 - Jan 20) / Ox ( Buffalo ) / Zhou
Aquarius ( Jan 21 - Feb 19 ) / Tiger / Yin Pisces (
Feb 20 - March 20 ) / Rabbit ( Hare ) / Nao Aries ( March 21
- April 20 ) / Dragon / Chen Taurus ( April 20 - May 21 ) /
Snake / Szu Gemini ( May 22 - June 21 ) / Horse / Wu
Cancer ( June 22 - July 23 ) / Goat ( Sheep ) / Wei
Leo ( July 24 - Aug 23 ) / Monkey / Shen Virgo ( Aug
24 - Sept 23 ) / Rooster / Yu Libra ( Sept 24 - Oct 23 ) /
Dog / Xu
Sex : Female Male
FSM (Female seeking Male) MSF (Male seeking Female) FSF (Female seeking Female) MSM (Male seeking Male)
Body Style / Type
/ Shape : Please select one ( 1 ) Under weight
Thin Ruler figure Slim
Slim / Sexy Athletic ( Slim / Sexy )
Athletic / Sexy Athletic Inverted
Triangle figure Petite Average
Hour Glass shape Large Pear
shape Spoon shape Over weight
go to Other Specifics Other Specifics
: Non Smoker : Smoker : Light / Social Drinker : Non Drinker :
Height Range : Please select one ( 1 ) if correct 152 cms / 5 ft 0
" - 155 cms / 5 ft 1" 157 cms / 5 ft 2 " - 160 cms / 5 ft 3
" 163 cms / 5 ft 4 " - 165 cms / 5 ft 5 "
168 cms / 5 ft 6 " - 170 cms / 5 ft 7 " 173 cms / 5
ft 8 " - 175 cms / 5 ft 9 " 178 cms / 5 ft 10 " - 180 cms / 5
ft 11 " 183 cms / 6 ft 0 " - 185 cms / 6 ft 1 "
188 cms / 6 ft 2 " - 191 cms / 6 ft 3 " 193 cms / 6
ft 4 " - 196 cms / 6 ft 5 " go to Other
Specifics Other Specifics :
Weight Range : Please select one ( 1 ) if correct 50 kgs / 110 lbs
- 52 Kgs / 115 lbs 54 Kgs / 120 lbs - 57 Kgs / 125
lbs 59 Kgs / 130 lbs - 61 Kgs / 135 lbs 64
Kgs / 140 lbs - 66 Kgs / 145 lbs 68 Kgs / 150 lbs - 70 Kgs /
155 lbs 73 kgs / 160 lbs - 75 Kgs / 165 lbs
77 Kgs / 170 lbs - 79 Kgs / 175 lbs 82 kgs / 180 lbs
- 84 Kgs / 185 lbs 86 Kgs / 190 lbs - 88 Kgs / 195
lbs go to Other Specifics Other Specifics :
Property Status(es) : Please select up to two ( 2 ) Home
own / paid off Home Rental / Lease Property
Rental / Lease Home Share Property
Share Home owe / paying off Home Rental /
Lease Share Property Rental / Lease Share
Live - in by arrangement(s) go to Other
Specifics Marital Status / Relationship :
Please select up to three ( 3 )
Sensual Never Married
Widowed Single Divorced
Separated Married Defacto
Live - in / Share Rent Home Assistant
Companion Friendship Business
Assistant Non - sensual go to Other
Specifics Children : Please select up to two ( 2 )
Children No Children want
Children No Children living at Home Children
living at Home go to Other Specifics Dependents : Please select up to two ( 2 )
Dependents No Dependents want
Dependents No Dependents living at Home
Dependents living at Home go to Other
Specifics Other Specifics / Marital & /
or Property Status(es) ; Child(ren) & / or Dependent(s) :
Hair Colour : Please select one ( 1 ) if correct blonde
blonde natural blonde light blonde
ash blonde dark fair brown
- blonde brown brown - red
chestnut red natural auburn
brunette black dark
go to Other Specifics Eyes Colour :
Please select one ( 1 ) if correct blue
blue - green blue - grey
green green - grey hazel
grey brown black
dark go to Other Specifics Other Specifics Hair &/or Eyes : Complexion / Other Characteristics :
Hobbies / Interests :
Sports / Activities :
Religion / Spirituality :
Likes / Dislikes :
Other : e.g. Travel Destination(s) / Holiday
Itineries / Activitie, etc.:
Page 3 of 4
I wish my First Name & Phone No. / nearest
Town / Suburb Locality Post Office Address ( or my Street Address ) & some
personal particulars, to be given to Travellers / Members of the following
details :-
Type of relationship(s) preferred :
Please select up to three ( 3 )
Travel / Holiday Date Travel / Holiday Mate
Travel / Holiday Companion Travel / Holiday
Activities Working Holiday Sports / Outdoor
Activities Sensual Companion
Non - Sensual e-pals Correspondence
pen-pals Correspondence Friendship
Live - in / Share Rent Live - in by
arrangement(s) Home Assistant Business
Assistant no preference go to Other
Specifics Other Specifics :
Preferred Country / Region(s) / Oceanic(s) :
Please select up to two ( 2 )
Australasia Europe North
Americas Asia Pacific South
Americas South Africas India
North Africas no preference go to
Other Specifics Other Specifics : Internet Country / Code(s) : Please select up to two ( 2 ) if correct
al Albania dz Algeria as American
Samoa aq Antarctica ar Argentina
au Australia at Austria bh
Bahrain bb Barbados be Belgium
bm Bermuda ba Bosnia & Herzegowina
br Brazil io British Indian Ocean Territory
vi British Virgin Islands bn Brunei
Darussalm bg Bulgaria kh Cambodia
cm Cameroon Islands ca Canada cv
Cape Verde Islands ky Cayman Islands cl
Chile cn China cx Christmas Island
co Colombia ck Cook Islands cr Costa
Rica hr Croatia cy Cyprus
cz Czech Republic ( cs former Czechoslovakia ) dk
Denmark tp East Timor ec Ecuador
eg Egypt sv El Salvador gq
Equatorial Guinea er Eritrea ee
Estonia et Ethiopia fk Falkland
Islands fj Fiji Islands fi Finland
fr France gf French Guiana pf French
Polynesia tf French Southern Territories gm
Gambia ge Georgia de Germany ( New
) gh Ghana gi Gibraltar gr
Greece gl Greenland gd Grenada /
Carricou gu Guam gt Guatemala
gg Guernsey gn Guinea gy
Guyana hn Honduras hk Hong Kong
hu Hungary is Iceland in
India id Indonesia ir Iran
iq Iraq ie Ireland im Isle of
Man is Israel it Italy jm
Jamaica jp Japan je Jersey
jo Jordan ki Kiribati, Gilbert Islands
kw Kuwait la Laos Peoples' Democatic
Republic lv Latvia lb Lebanon
ly Libyan Arab Jamahiriya li Liechtenstein
lt Lithuania lu Luxembourg mo
Macao mk Macedonia mg Madagascar
my Malayia mv Maldives mt
Malta mh Marshall Islands mu
Mauritius mx Mexico fm Micronesia
mc Monaco ms Montserrat ma
Morocco mm Myanmar ( Burma ) nr
Nauru np Nepal nl Netherlands
nc New Caledonia nz New Zealand ni
Nicaragua nf Norfolk Island kp North
Korea no Norway om Oman pk
Pakistan ps Palestine pa Panama
pg Papua New Guinea py Paraguay pe
Peru ph Philippines pn Pitcairn
Island pl Poland pt Portugal
pr Puerto Rico qa Qatar re Reunion (
France ) ro Romania ru Russia ( su former
USSR ) sh Saint Helena lc Saint
Lucia sm San Marino sa Saudi Arabia
yu Serbia & Montenegro ( ex Yugoslavia ) sc
Seychelles sl Sierra Leone sg
Singapore sk Slovakia si Slovenia
so Somalia za South Africa kr South
Korea sb Solomon Islands es Spain
lk Sri Lanka se Sweden ch
Switzerland sz Syrian Arab Republic tw
Taiwan tz Tanzania th Thailand
to Tonga tt Trinidad & Tobago tn
Tunisia tr Turkey ua Ukraine
ae United Arab Emirates uk United Kingdom ( gb Great
Britain ) us United States of America ( U.S.A. )
um United States Minor Outlying Is vi US Virgin
Islands uy Uruguay vu Vanuatu
va Vatican City State ( Holy See ) ve
Venezuela vn Vietnam wg Western Jordan &
Gaza eh Western Sahara ws Western
Samoa zm Zambia zw Zimbabwe
no preference go to Other Specifics
Other Specifics :
Sex : Female Male Age Range(s) : Please select up to two ( 2 ) 18 -
24 years 25 - 29 years 30 - 34
years 35 - 39 years 40 - 44 years
45 - 49 years 50 - 54 years 55 - 59
years 60 - 64 years 65 - 69 years
no preference go to Other
Specifics Other Specifics : Star / Animal Sign(s) : Please select up to two ( 2 ) Year(s) - Month(s)
Animals / Earthly Branches Scorpio ( Oct 24 - Nov 22 ) / Pig
( Boar ) / Hai Sagittarius (Nov 23 - Dec 21) / Rat /
Tzu Capricorn (Dec 22 - Jan 20) / Ox ( Buffalo ) /
Zhou Aquarius ( Jan 21 - Feb 19 ) / Tiger / Yin
Pisces ( Feb 20 - March 20 ) / Rabbit ( Hare ) / Nao
Aries ( March 21 - April 20 ) / Dragon / Chen Taurus
( April 20 - May 21 ) / Snake / Szu Gemini ( May 22 - June 21
) / Horse / Wu Cancer ( June 22 - July 23 ) / Goat ( Sheep )
/ Wei Leo ( July 24 - Aug 23 ) / Monkey / Shen
Virgo ( Aug 24 - Sept 23 ) / Rooster / Yu Libra (
Sept 24 - Oct 23 ) / Dog / Xu no
preference Non Smoker : Smoker : Light / Social Drinker : Non Drinker : Body Style(s) / Type(s) / Shape(s) : Please select up to two ( 2 ) Under
weight Thin Ruler figure
Slim Slim / Sexy Athletic ( Slim /
Sexy ) Athletic / Sexy Athletic
Inverted Triangle figure Petite
Average Hour Glass shape
Large Pear shape Spoon
shape Over weight no preference
go to Other Specifics Other Specifics
:
Height Range(s) : Please select up to two ( 2 ) 152
cms / 5 ft 0 " - 155 cms / 5 ft 1" 157 cms / 5 ft 2 " - 160
cms / 5 ft 3 " 163 cms / 5 ft 4 " - 165 cms / 5 ft 5
" 168 cms / 5 ft 6 " - 170 cms / 5 ft 7 "
173 cms / 5 ft 8 " - 175 cms / 5 ft 9 " 178 cms / 5
ft 10 " - 180 cms / 5 ft 11 " 183 cms / 6 ft 0 " - 185 cms /
6 ft 1 " 188 cms / 6 ft 2 " - 191 cms / 6 ft 3 "
193 cms / 6 ft 4 " - 196 cms / 6 ft 5 " no
preference go to Other Specifics Other Specifics :
Weight Range(s) : Please select up to two ( 2 ) 50 kgs / 110
lbs - 52 Kgs / 115 lbs 54 Kgs / 120 lbs - 57 Kgs / 125
lbs 59 Kgs / 130 lbs - 61 Kgs / 135 lbs 64
Kgs / 140 lbs - 66 Kgs / 145 lbs 68 Kgs / 150 lbs - 70 Kgs /
155 lbs 73 kgs / 160 lbs - 75 Kgs / 165 lbs
77 Kgs / 170 lbs - 79 Kgs / 175 lbs 82 kgs / 180 lbs
- 84 Kgs / 185 lbs 86 Kgs / 190 lbs - 88 Kgs / 195
lbs no preference go to Other
Specifics Other Specifics :
Preferred Marital Status(es) / Relationship(s) :
Please select up to two ( 2 ) Never
Married Widowed Single
Divorced Separated Married
Defacto Live - in Companion
Friendship no preference go to Other
Specifics Children : Please select up to two ( 2 )
Children No Children want
Children no Children living at Home Children
living at Home no preference go to Other
Specifics Dependents : Please select up to two ( 2 )
Dependents No Dependents want
Dependents no Dependents living at Home
Dependents living at Home no preference
go to Other Specifics Preferred
Property Status(es) : Please select up to two ( 2 ) Home
own / paid off Home Rental / Lease Property
Rental / Lease Home Share Property
Share Home owe / paying off Home Rental /
Lease Share Property Rental / Lease Share
Live - in / Share Rent no preference
go to Other Specifics Other
Specifics / Marital & / or Property Status(es) ; Child(ren) & / or
Dependent(s) :
Preferred Hobbies / Interests :
Preferred Sports / Activities :
I UNDERSTAND THAT ONLY I WILL GIVE ADDITIONAL
PERSONAL DETAILS TO ANY CALLERS / ADDRESSEES THAT I FEEL I WOULD LIKE TO CONTACT
FURTHER
I CERTIFY THAT ALL
INFORMATION THAT I HAVE SUPPLIED ON THIS APPLICATION FORM ARE TRUE &
CORRECT, & HEREBY AUTHORISE USE , INCLUDING PHOTO(S) ( IF ANY ), IN ALL OF
Country City Contacts
SERVICE(S)
I AGREE THAT
Country City Contacts cannot / will
not, accept any responsibility of any meetings or contacts between Travellers
/ Members and / or other persons ; & reserve the right to refuse or
withdraw membership of any persons, at Country City
Contacts' sole discretion.
FULL NAME : SIGNATURE : DATE : D : / M : / Y : ( Country City Contacts Applicant ) Computer
Generated / CCC Applicant Membership / Registration Number :
PLEASE MAKE COPIES OF THIS APPLICATION FORM; FOR
NOTICE BOARDS, & FURTHER COPIES TO FELLOW TRAVELLERS, FRIENDS &
FAMILY.
your CCC Membership
/ Application Form :- Pages 1 , 2, & 3 of 4
cut/tear=========================================================================================cut/tear
Page 4 of 4
To pay Country City
Contacts your CCC Membership / Registration AUD $ 35 ( Australian
dollars ) by BankSA Direct Credit(s) / Deposit(s), Credit Card, Bank
Check ( Cheque ), or International Money Order, in that order of preference,
please complete this last Page 4, of 4 ; Please edit & post ONLINE OR download, print, fill - in
& post OFF - LINE ; All Confirmation(s)
copies ; Post to your ( Debit ) Financial Institution
for Payment. ; & ON - LINE, post by e - mail
to contacts@travellersoz.com.au OR OFF - LINE, post by conventional mail to
C/o BankSA, Head Office, 97 King William Street, ADELAIDE, SA 5000,
AUSTRALIA.
Your Payment Method(s) :- Visa Card : Mastercard : Bankcard : American Express :
Diners
International :
Please charge AUD $ 35 to your Credit Card. Card
Expiry Date : Day :
/ Month : / Year : Your Credit Card Number : - / / / Your Credit Card Verification Number / Electronic
Commerce indicator values ( " eCommerce Indicator " ) : - ( the last three ( 3 ) Digits printed on the Signature Strip located
on the back of your Credit Card )
or Your Other Payment Method(s) :- Bank Check (
Cheque ) or
International Money Order or Direct Credit(s) / Deposit(s) to
Cowandilla Nominees Pty. Ltd.
BRANCH
Name of Financial Institution
ACCOUNT TYPE
SWIFT CODE
BSB No.
Card / Account Number
receiving [ Credit ] Financial
Institution
Please CREDIT AUD $
35 to :-
Bank of South Australia
CHECK (CHEQUE)
SBSAAU5A
105 - 000
0931966740
CR
OR
Australian & New Zealand Bank ( A . N . Z . )
VISA CARD
4509 4952 3091 9177
CR
Full Address : Bank SA, Head Office, 97 King
William Street, Adelaide, SA 5000, AUSTRALIA, OR VISA CARD , Card Services,
Australian & New Zealand Banking Group Limited ( A . N . Z . ), 13 Grenfell
Street, Adelaide, SA 5000, AUSTRALIA.
Pay your DEBIT AUD $ 35 from : DR ( your paying [ Debit ] Financial
Institution )
Full Name & Address of your paying ( Debit )
Financial Institution : Expiry DATE : D :
/ M : / Y :
FULL NAME : SIGNATURE : DATE : D : / M : / Y : ( Credit Card / Account Holder only )
if Credit Card / Account Holder is different
from Country City Contacts Membership / Registration Form, Applicant , above
: Full Address : E-mail Address(es) :
Toll Free Telephone / Fax ( if any ) : International
Access Code : - Country Code : - Area Code :
- Telephone : Fax : Number : Best Time to Ring / Send : pm : or am :
your CCC Membership
/ Registration & Payment(s) Authority AUD $ 35 :- Page 4 of
4
Hold down 'shift' while clicking this link toDownload text
version of CCC Application form Best viewed and edited in notepad
with word wrap on.
PLEASE MAKE COPIES OF THESE POSTERS FOR
NOTICE BOARDS, SO THAT YOU CAN ALSO GIVE COPIES TO FELLOW TRAVELLERS, FRIENDS
& FAMILY Lists Intro. | Send Form(s) | Listings | Posters | Hostel
Features | Bookings | CCC
Intro. | CCC
Application(s) | J.M.W. Open
Letter | Peterborough
Profile | Trains &
Racing | Old
Ghan Route | Walks
& Tours | Graffiti | Guests Book(s) |
Links | Home Enquiries Jeff M. Weeks ; Copyright © 1995 - 2000 COWANDILLA NOMINEES
Pty Ltd A.B.N. 64 008081838 Web address; http://www.travellersoz.com.au Email address; contacts@travellersoz.com.au