THE MIDWEEKER
ABN 35 254 714 099

PO BOX 127 WILLOUGHBY NSW 2068 PHONE OR FAX (02) 9958 3870
EMAIL: burrow@midweeker.com.au

THE MIDWEEKER ORDER FORM

Please print out this form on completion and mail together with your paymernt to:
THE MIDWEEKER, PO BOX 127, WILLOUGHBY 2068

NOTE: THIS FORM CAN BE SENT BY EMAIL BUT WILL NOT BE PROCESSED
UNTIL PAYMENT IS RECEIVED.
Name:

Address:

City/State::

Postcode:

Phone:

Email:


Subscription type?

Individual issue Trial date: Introductory rate

Payment type?
NOTE: Electronic payment over the internet will be made available in the near future.

Cheque Money Order

Amount enclosed:

Do you subscribe to PICTUREFORM?

YES NO

Would you prefer to receive THE MIDWEEKER by email?

YES NO

Which browser do you use?

Internet Explorer Netscape Communicator Other

Which computer system do you use?

PC Macintosh Other

Home