Friends of Kurth Kiln Group

Application for Membership

I

Mr Mrs Ms age

hereby apply for membership in the Friends of Kurth Kiln Group

My membership category is:

My current address phone

City State Fax...

Postcode Country Email

The following details are helpful in the administration of the Group and for future reference. You may furnish this information at your discretion:

Occupation/Profession Conjugal status

Hobbies Spouse's Name

Children - tick for yes and list Name and Date of birth of children:

To complete your application, press the Submit Application button. To make changes in your details press the Reset All button.

Wewill immediately place your name on our mailing list and send you our current meeting dates and minutes. Payment of your Membership contribution can be made at the next Meeting or, if you prefer, sent to

Friends of Kurth Kiln, Post Office Box 169 WOORI YALLOCK Victoria 3139
E-mail: auk@c031.aone.net.au