WYONG FAMILY HISTORY GROUP Inc
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APPLICATION FOR MEMBERSHIP RENEWAL
1.7.2020 - 30.6.2021
Single membership $30.00
Family membership $37.50
These fees include a 25% Discount due to COVID-19
Personal information
*
Indicates required field
Title
*
Mrs
Ms
Miss
Mr
Membership Number/s
*
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Postal Address (if different)
*
Line 1
Line 2
City
State
Zip Code
Country
Contact phone number (s)
*
Mobile phone number
*
Email
*
Past/Present Occupations
*
In Case of Emergency Contact Name and Phone Number
*
I would be willing to help with
*
Research room assistant (training provided)
Library room helper
Data collection
Fund raising
For our personal accident voluntary workers policy please tick appropriate age bracket (s)
*
10 - 50
51 - 70
71 - 85
Over 86
I will pay by
*
Credit card online
Direct deposit
Cash / Cheque to cottage
SUBMIT THIS FORM THEN PROCEED TO PAYMENT