CREDIT CARD AUTHORITY
CREDIT CARD AUTHORITY The
Treasurer Lithgow & District Family History
Society Inc Lithgow
NSW 2790 Please
debit the sum of $
..to my
VISA
..MASTERCARD
...(Tick Card type) Card Number _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _
_ Expiry Date _ _ / _ _ Cardholders
Name:
Signature:
. Being
payment for: (please tick box) Membership
(including joining fee, if applicable) Journal
Subscription Purchase
of Books or microfiche (attach separate list) (PLUS POSTAGE) Research
Enquiry Fee Other - Please supply details:
NAME:
... ADDRESS:
.
...POSTCODE
DATE:
. EMAIL ADDRESS:
. PHONE
NUMBER:
. CREDIT CARD AUTHORITY The
Treasurer Lithgow & District Family History
Society Inc Lithgow
NSW 2790 Please
debit the sum of $
..to my
VISA
..MASTERCARD
...(Tick Card type) Card Number _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _
_ Expiry Date _ _ / _ _ Cardholders
Name:
Signature:
. Being
payment for: (please tick box) Membership
(including joining fee, if applicable) Journal
Subscription Purchase
of Books or microfiche (attach separate list) (PLUS POSTAGE) Research
Enquiry Fee Other - Please supply details:
NAME:
... ADDRESS:
.
...POSTCODE
DATE:
. EMAIL ADDRESS:
. PHONE
NUMBER:
.
The Treasurer
Lithgow & District Family History Society Inc
Lithgow NSW 2790
Please debit the sum of
$
..to my
VISA
..MASTERCARD
...(Tick Card type)
Card Number _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _ Expiry Date _ _ / _ _
Cardholders Name:
Signature:
Being payment for: (please tick box)
Membership (including joining fee, if applicable)
Journal Subscription
Purchase of Books or microfiche (attach separate
list)
(PLUS POSTAGE)
Research Enquiry Fee
Other -
Please supply details:
NAME:
...
ADDRESS:
.
...POSTCODE
DATE:
. EMAIL ADDRESS:
.
PHONE NUMBER:
.