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The Ballarat & District Genealogical Society Inc. Website : http://www.ballaratgenealogy.org.au |
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Membership No: ......................... (renewals only). Surname: ............................................ Given Name : ...................................................................... Title : ............................................ Postal Address : ................................................................................................................... ............................................................................................................................................. Postcode : .................................... Country : ........................................................................ Phone (home) ............................................... Phone (business) ............................................ Email : ...............................@............................................................................................... |
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I / We wish to apply for: (please tick appropriate boxes)
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New Membership |
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Renewal of Membership |
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Single Membership ($25.00) |
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Family Membership ($35.00) |
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Overseas Membership ($25.00)AUS |
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Membership year from 1st July to 30th June (half price after 1st Jan.)
I / We agree to abide by the rules and regulations of the above Society
NOTE: Credit card facilities are NOT available for payments.
Signed : ........................................................ Date : .....................................................
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