APPLICATION FOR MEMBERSHIP

Secretary
Parramatta & District Historical Society Inc.
P.O. Box 1384
PARRAMATTA NSW 2124

Dear Secretary

I wish to join the Parramatta & District Historical Society Inc. and hereby put my name forward for election. I understand full membership commences after payment of the joining fee, annual subscription and acceptance by the members.

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

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

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

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Office Use only :

Acceptance:

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

Newsletter: ……………………………………..

Confirmation letter:……………………………

Membership No………………………………

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