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
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Membership Application Form

To: Secretary
American Civil War Roundtable 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: INC9882123)

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 enclose a cheque for $40* payable to ACWRTA (NSW Chapter) OR paid by EFT to BSB: 802 058 Ac: 100014696 (Date: ___ / ___ / 20___ ).

* The membership fee for those living outside the metropolitan area is $35.00

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 _______________