Anglesea & District Historical Society Inc.
P.O. Box 98, Anglesea, Victoria 3230.

MEMBERSHIP APPLICATION

Please print this form. Bring to a meeting or post to above.

Mr/ Mrs/ Miss/ Ms Surname .................................
Given Name(s) .................................
Street Address & Postal Address

.................................

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Local Phone Number .................................
Melbourne Phone Number .................................
Mobile Phone Number .................................
E-mail Address .................................

Membership includes our quarterly newsletter.

Single ADHS membership: $20.00
Plus optional Family History membership: $15.00 per person or family

Yearly membership in total for both: $35.00

Bank account: Bendigo Bank. BSB: 633-108 Account: 1430 28421.

Please note for insurance purposes Surf Coast Family History Group Membership requires membership of Anglesea & District Historical Society Inc.

Updated 15 Sep 2015