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Please print this form and, after completing it, send it with your cheque
to:
The Woodend & District Heritage Society
PO BOX 124, WOODEND, 3442. Australia
Your Full Name________________________________________Date______________
Postal Address___________________________________________________________
_____________________________________________________PostCode__________
Phone Number home _____________________________
Phone Number business _____________________________
Fax Number
_____________________________
Email Address
_____________________________
Membership fees:
Individual: $20.00
Concession or Full-time Student: $15.00
Family: $25.00