ENOGGERA & DISTRICTS HISTORICAL SOCIETY INC
P O Box 200 - Alderley QLD 4051
Membership / Renewal Form

HEADING
  
DETAIL

Name/s or
Business Name or
Association:
 ( PLEASE PRINT)

  

Address:
(Include PostCode)
  

Phone:
(Home)
  
Phone:
(Work)
  
Phone:
(Mobile)
  
Email:
  
Signature/s:
  

 

 
Date:
  

Annual Membership Types
Cost $
Tick
Ordinary
10
Family (Couple with children under 18 years)
15
Concession
5
Junior (Not permitted to vote at meetings)
5
Business
20
Association
20

Complete this form then send with your payment to: The Secretary, Enoggera & Districts Historical Society, P O Box 200, ALDERLEY QLD 4051

PRINT: Either type in the relevant fields and/or use your browser's print options or RIGHT mouse click this form, then select the PRINT option, then OK to print the SELECTED frame