Print & send to:                   Gisborne & Mount Macedon Districts Historical Society Inc.

                                            P.O. Box 113 Mount Macedon
                                            Victoria, 3441, Australia

 

or print & fax to:                   03   5428 1534

 

or copy, paste & email to:   history@gisbornemountmacedon.org.au

 
 

GISBORNE & MT. MACEDON DISTRICTS HISTORICAL SOCIETY INC.
ABN 82 893 878 458 Inc. No. A 0027147L
 

MEMBERSHIP APPLICATION FORM

 

I/We:
ADDRESS:
 
 
PHONE: POSTCODE:
*E-MAIL: *WEBSITE:
desire to become a Full Member of the

GISBORNE & MOUNT MACEDON DISTRICTS HISTORICAL SOCIETY INC.
ABN 82 893 878 458 Inc. No. A 0027147L
In the event of my admission as a Member, I/we agree to be bound by the rules of the Society for the time
being in force.
 
NAME OF THE APPLICANT:
SIGNATURE OF THE APPLICANT:

 

 DATE: