APPLICATION FOR MEMBERSHIP

                                                   Please Print  & Return 

Secretary
Parramatta & District Historical Society Inc.
P.O. Box 1384
PARRAMATTA
NSW 2124
email: parramattahist@tpg.com.au

Dear Secretary

I wish to join the Parramatta & District Historical Society Inc.

I understand full membership commences after payment of an annual subscription and acceptance by the members. 

INDIVIDUAL MEMBER: Annual Subscription $30 – total $40.00

FAMILY MEMBER:    Annual Subscription $40 – total $50.00

FULL NAME : (Dr/Mr/Mrs/Miss/Ms)..........…………............................................................................

ADDRESS :….......................................................................................................................

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TELEPHONE : (Home)...............................................................

                        (Bus.)………………………………………………

                        (Mobile)……………………………………………

E-MAIL :.......................................................................................................................

If STUDENT:               Student No.                        School/Uni./College                                                                               

INTERESTS :…………………………………………………………………………….................................................…

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DATE : ......................................................................................

SIGNATURE : ..........................................................................

Send your application by email or post to the Society at the address shown at the top left of the form. 
Please also pay the Annual Subscription by either:
(a) Direct Transfer to the Society's account at CBA Parramatta, BSB 062-223, Account 00900240, including MEMB and your name in the reference
(b) By cheque or mail order, payable to "Parramatta & District Historical Society"

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Office Use only :

Acceptance:

Receipt No. .................

Newsletter: ……………………………………..

Confirmation letter:……………………………

Membership No………………………………
 

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