Membership Application / Renewal Form

Application / Renewal (If Renewal Quote Member Number)

A$10  Joining Fee For all Memberships		Number of Convicts descended from
A$15  Single Membership		A$150 Single Life Membership
A$20  Joint or Family Membership		A$200 Joint Only Life Membership

See Membership page for detailed description of each type of Membership

If joining as a Family Member, name of partner and/or Children under 18. In case of children dates of birth must be supplied.

Address
State	Postcode
Telephone No.
email Address
Web Page:	http://
Signature	Date     /     /

Please print this form, then mail it, together with Joining Fee and Subscription or Renewal (in Australian Dollars) to:

The Membership Secretary,
The Descendants of Convicts Group Inc.
P O Box 115
Flinders Lane
VICTORIA 8009
AUSTRALIA