American Civil War Round Table of Australia
New South Wales Chapter
(an incorporated association)

Phone: 02 9449 3720 ..... Email: type address into your mail program ..... Website: www.americancivilwar.asn.au
______________________________________________________________________________

Membership Application Form

To: Secretary, American Civil War Round Table of Australia (NSW Chapter), P O Box 200, St. Ives NSW 2075

I hereby apply to become a member of the American Civil War Round Table of Australia (NSW Chapter) Inc. (NSW Incorporated association number: INC 9882123)

For Members Register:

Name _____________________________________________________ Occupation __________________________

Address ___________________________________________ Suburb/Town __________________ Postcode: ______

Other contact information:

Phone ( __ ) _____________ Mobile: _______________ Email: _____________________@___________________
Please print carefully

In the event of my admission as a member, I agree to be bound by the rules of the association for the time being in force:

Signed: ____________________________ Date _______________ 20___

I live in the Sydney metropolitan area and paid by EFT to BSB: 082 445 Ac: 413569756 (Date: ___ / ___ / 20___ )
OR enclose a cheque for $45* payable to ACWRTA (NSW Chapter).
* The membership fee for those living outside the metropolitan area is $40.00

I _____________________________________ a member of the association, nominate the applicant, who is personally known to me, for membership of the association.

Proposer to sign: _________________________ Date _______________

I ____________________________________ a member of the association, second the nomiation of the applicant, who is personally known to me, for membership of the association.

Seconder to sign: _________________________ Date _______________