SOUTH EAST FAMILY HISTORY GROUP INC.

P.O. Box 758, Millicent, S.A., 5280

Research Centre – 1A Mt Gambier Road, Millicent

Phone: 08 8733 1100 www.sefhg.org Email info@sefhg.org

APPLICATION FOR MEMBERSHIP

Surname ____	Christian Names

Some names being researched are:

Postal Address

State	Postcode

Email Address

Residential Address (optional)

State	Postcode

Private Telephone	Business Telephone	Occupation

Pension Number

MEMBERSHIP FEES - (tick type required)

FAMILY	$30.00	SINGLE $30.00

PENSIONER	$25.00	The quarterly Newsletter is included in the fee

MEMBERSHIP APPLICATION

I hereby make application for membership of the South East Family History Group Inc. and enclose a remittance of $	representing the annual subscription for a ____________member rate.

I agree to be bound by the objects and regulations (as amended) of the Group which I understand are available from the Librarian.

In consideration of the South East Family History Group Inc. (S.E.F.H.G.) approving my application for membership, I:-

(a) will comply with any direction of the S.E.F.H.G. and its staff.

(b) agree to accept and be bound by the records of the Group with respect to

the borrowing and use of the assets of the S.E.F.H.G.

(c) will uphold and protect the aims of the S.E.F.H.G.

Signature of Applicant

this the	day of	20

OFFICE USE ONLY

SURNAME	Receipt No.	Date Amount Member No.