HUGUENOT SOCIETY OF AUSTRALIA INCORPORATED

(incorporated under the NSW Associations Incorporation Act 1984)

Date __________________

Membership Secretary
Huguenot Society of Australia Inc
P.O.Box 421
KATOOMBA NSW 2780

2008 MEMBERSHIP APPLICATION

(Membership is for a calendar year)

I/We wish to become a member of the Huguenot Society of Australia Incorporated and agree to be bound by its rules and regulations. See our Internet Web Site or request a copy.
My/our cheque/AMO payable to "Huguenot Society of Australia Inc" is enclosed for $

My/our details are as follows: Please PRINT clearly.

	2008 Single Subscription $25	2008 Joint Subscription $35
For a Joint membership please complete the details under the Single and Joint subscription boxes. Both persons should sign the application if practical.	please tick appropriate box Mr Mrs Ms Miss Dr Rev Other (please specify) _________________	Second name please tick appropriate box Mr Mrs Ms Miss Dr Rev Other (please specify) _________________
First given name or name you wish to be called by
Surname
Huguenot families with which Huguenot connection claimed & Research Surnames only ** See below. Print details on back if necessary.
Mailing address (for a Joint membership, only one postal address to be supplied)
	[State][Post Code]
Phone No.	()
E-Mail address	Please PRINT correct case (upper/lower) and ensure all letters are legible.

**Member Service: We will publish Huguenot connection surnames plus other surnames you are researching in the Huguenot Times to assist study. Your name, address and email address will be published so others may contact you. IF YOU WANT PUBLICATION PLEASE TICK THE BOX

The Huguenot Society of Australia Inc respects your privacy and the personal information you have disclosed above will not be passed or sold to any other organisation. Contact details may be passed to other members of the Society only.

Sincerely