||American Civil War Round Table of Australia
New South Wales Chapter
(an incorporated association)
Phone: 02 9449 3720 .....
..... 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 _______________