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HMAS MELBOURNE ASSOCIATION
PLEASE NOTE : THIS IS THE ONLY FORM ACCEPTED
MEMBERSHIP APPLICATION AND RENEWAL FORM
Melbourne Assoc. Number................... Preferred or Nickname....................
________________________________________________________
Title Given Name SURNAME
_____________________________________________________________________
No Street City State Postcode
Next of Kin details_______________________________________________________
Given Name SURNAME RELATIONSHIP
Only complete the information below if you are a new member or your current information has changed.
Telephone_______________________ Fax ____________________
Email ___________________________ Mobile (Secretary only) _____________________
Served in Melbourne in _______________________________________________
(Give years only)
Joining fee $10 Annual Subscription $10
Please return to The Secretary, HMAS Melbourne Association, 2 Bottlebrush Ave, Bradbury, NSW 2560
Receipt required NO / YES (include stamp)
Committee
President Bob Burchill 28 Chircan St., Old Toongabbie, NSW 2146 rburchill@bigpond.com *** Vice President Vince Fazio, 39 Railway St., Petersham, NSW 2049 vrfazio@optusnet.com.au *** Secretary/ Treas. Mitch Miller 2 Bottlebrush Ave, Bradbury, NSW, 2560 mitchklmiller@optusnet.com.au *** Asst. Sec/Treas. Adrian Halley, 7/9 Viola St, Punchbowl, NSW, 2196 *** Member Dean Gedling, 75 Campbellfield Ave, Bradbury, NSW 2560 ph 4626-1802 *** Qld Delegate John Dillon 23 Bolwell St., Runcorn, Qld 4113 *** Tas Delegate Colin Smee 4 Cornwall St., Beaconsfield, Tas 7270 *** SA Delegate Dave Rickard 34 Nungamoora St., Hallet Cove, SA 5158 *** Vic Delegate Tony Wilson, 14 Namnans Way, Sunbury, Vic 3429 *** WA Delegate Merv Mancer PO Box 1532 Bunbury WA 6231 *** ACT Delegate Peter Boden 26 Marlock St, Rivett, ACT 2611