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

MEMBERSHIP APPLICATION

Please print this form

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

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

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

Local Phone number .................................
Melbourne Phone number .................................
E-mail Address .................................

Membership includes our quarterly newsletter.

Single ADHS membership: $15.00
Family History Membership $15.00

Yearly membership in total $30.00

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