Join The 3068 Group Inc

The 3068 Group Membership Application or Renewal

I wish to become a member of the 3068 Group: - Yes No

I wish to renew my annual membership of the 3068 Group: - Yes No

I wish to register a change of address: - Yes No

I do not wish to join but would like to receive 3068 news by email: - Yes No

Date

Name:

Other Names [for Joint membership]:

Street Address or P.O. Box:

Suburb:

Post Code:

Phone [optional]

[A.H.]

[B. H.]

[Mob]

Email [optional]

The committee of the 3068 Group will not disclose the membership list to any other party.

I wish to receive monthly minutes and news by email: - Yes No

I include my $10 annual membership: - Yes No

I also include a donation of $

Please return this form to the address below, or in person to a member of the 3068 committee.

Together with $10 annual membership send to:

The Secretary,

PO BOX 118.
Clifton Hill Vic. 3068

Your details will not be forwarded to any third parties unless required by law.

Thank you for supporting the 3068 Group.

The 3068 Group - Registration No.A0037277N, ABN 61 907 325 331