APPLICATION FOR MEMBERSHIP

The Braidwood & District Historical Society Inc. 
186 Wallace Street, PO Box 145, NSW 2622
Telephone (02) 48422310
Email: help@braidwoodmuseum.org.au

Name ________________________________________________________________________


Address ________________________________________________________________________________________________________________________________________________
________________________________________________________________________


Phone __________________ E-mail ______________________


Subscription Fee $10 per person or $15 per family.
Paid Cash_______or Cheque______


I HEREBY APPLY TO BECOME A MEMBER OF THE BRAIDWOOD AND DISTRICT HISTORICAL SOCIETY INC.

I AGREE TO BE BOUND BY THE RULES OF THE SOCIETY.


 
_______________________________________________
_________________________                         Signature of Applicant

Date          ___________________________