LITHGOW &
DISTRICT FAMILY HISTORY SOCIETY INC
PO BOX 516, LITHGOW NSW 2790
E-mail:
ldfhs@lisp.com.au
Web-site: http://www.lisp.com.au/~ldfhs
(Incorporated under the Associations Incorporation Act, 1984)
APPLICATION FOR MEMBERSHIP OF THE SOCIETY
I/We Mr/Mrs/Miss/Ms
...
(Full Name of Applicant/s)
of
...
(Address)
(Postcode)
Phone Number: Occupation
E-mail Address
I/we hereby apply to become a member of the above-named incorporated society.
In the event of my/our admission as a member/s, I/we agree to be bound by the
rules of the society for the time being in force.
I/we have/have not been a member of this society before.
Type of Membership required (please tick one):
Single Family Corporate
.
(Signature of Applicant/s)
Date
..
I,
, a member of the society, nominate the
(Full name of Proposer)
applicant/s, personally known to me, for membership of the society.
Signature of the Proposer: .. Dated: .
I,
, a member of the society, nominate the
(Full name of Seconder)
applicant/s, personally known to me, for membership of the society.
Signature of the Seconder:
..
Dated:
.
OFFICE USE ONLY
Receipt No: Amount Paid:
Membership
No:
Code of Ethics Letter signed: