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