MEMBERSHIP APPLICATION Name:( Mr/Mrs/Ms)________First__________________Last__________________________ Name:( Mr/Mrs/Ms)________First__________________Last_________________________ Postal Address:____________________________________________________________ ___________________________________________________________Postcode:_______ Phone: _______________________E-mail:________________________________________ I/we hereby apply to become member/s of the Port of Yamba Historical Society . I/we agree to be bound by the rules of the Society currently in force. Signature ________________________________________ Date :________________ Signature ________________________________________ Date: ________________ I, a member of the Port of Yamba Historical Society nominate the applicant, who is personally known to me, for membership of the Society. Signature of the proposer
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I, a member of the Port of Yamba Historical Society second the nomination of the applicant, who is personally known to me, for membership of the Society. Signature of the Seconder ..Date: MEMBERS REGISTER Privacy Regulations- The Port of Yamba Historical Society requires the above information in order to communicate more effectively within the Society. If you do not authorise the information to be held in the records of the Society, and to be used in connection with the Society's operations, you will be limiting the Society's ability to communicate effectively. If you are willing to have your name included in the Society's records, please take a minute to show your endorsement by signing hereunder. For further information Contact our Secretary, on 6646 1399 Signature:_______________________________ Signature_______________________________ For Office Use Only Receipt No: Date: Card Issued: Members Register Entered: Contact Survey: |
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