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.
$2:00 extra to have it posted.

Single ADHS membership: $15.00
Family History Membership $12.00

Yearly membership in total $27.00

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

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