RETURN TO:
The Surveyor-General
GPO Box 158
		CANBERRA ACT 2601
Dual NSW/ACT Registration – Continuation Notice

I, (Name): 											of

(Residential Address)
wish to maintain/seek dual NSW/ACT registration and will pay the combined annual registration fee to the Board of Surveyors and Spatial Information of NSW.

Tel: (h)						Date of Birth:

Company Name:

Business Address:

Tel: (w) 			Fax:			(mob):

Preferred Postal Address:    Home: 	Business: 	Email:					
Have these details changed from last year?   YES  	NO  

Signature:							Date:				

Do not send any payment with this Continuation Notice