Name(s): __________________________________ Birth Year(s): ________
Address: _______________________________
_______________________________
_______________________________ Phone: _________________
Post Code: ________ email: _________________________________________
Please tick the appropriate boxes:
I do [ ] do not [ ] give my permission for the Lake Macquarie Family
History Group Inc to list my research surnames on their Web site
including my member number which links to my email address.
(your member number will only appear if you have no email address)
I do [ ] do not [ ] agree to my name, address, phone no & email address
being given to persons researching the same family names as myself.
Signature: __________________________________ Date: ______________
ANNUAL MEMBERSHIP SUBSCRIPTION: Single: $30 [ ]
(Pro-rata rates apply
throughout the year) Family: $40 [ ]
Total enclosed: $__________
Please make cheque/money order payable to
Lake Macquarie Family History Group Inc.
ALL MEMBERSHIP RENEWALS ARE DUE BY 1ST JULY EACH YEAR
Forward application to:
The Secretary,
Lake Macquarie Family History Group Inc.
PO Box 639
TORONTO NSW 2283