Tamworth & District Family History Group Inc

Application/Renewal of Membership

Please fill in your details, print it, sign it and return to the address below

Name:

Address:

City:

State:

P/code:

Country:

Phone:

Fax:

Email:

Please indicate with an (X) which fee structure. All Fees are due on the 1st of July each year.

New Membership

Renewal

$5.00 Initial Joining Fee ...... (One time only or if membership lapses)

$35.00 Family Membership

$30.00 Single Membership

$20.00 Students & Pensioners

I hereby agree that I will not use any of the group's resources as a profit making venture for myself.

Signature :___________________________________ Date :________________

..................................................................................................................................................................................

N.B. If you have a current Australian Pensioners Healthcare Card, Please photocopy both sides
and include with your correct remittance.
Your card details are NOT kept, it only needs to be sighted.

Please return the above form with a Cheque or Money Order in Australian Dollars.

To: The Secretary

Tamworth & District Family History Group Inc.
P.O. Box 1188,
TAMWORTH NSW 2340
AUSTRALIA.