The Saint David's Welsh Society of Brisbane

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MEMBERSHIP APPLICATION FORM

 

 

Please complete the following information:

 

Your title ……………………………………………………..

First name/s ………………………………………………….

Preferred Name …………………………….……………….

Surname ……………………………….…………………….

Address  ……………………………………………..….……

 ……………………………….………….….…..…..

 ……………………………………………..…..…..

Postcode …………………………………………………….

Telephone (H)         …………………………..

                  (W)         …………………………..

            Mobile          …………………………..

Email                        ……………………………………….…

Type of Membership …………………….…..

Amount sent            $………….....

 

Membership fees are due by 1st March each year and are:

            Single member         $25.00

            Couple and family    $30.00

            Single concession   $15.00

            Family Concession     $25.00

 

All fees to be mailed to     

Secretary

                        214 Archerfield Road

                        RICHLANDS 4077