History House Museum &
Research Centre


MEMBERSHIP

GLEN INNES & DISTRICT HISTORICAL SOCIETY Inc.
PO Box 371 GLEN INNES NSW 2370

MEMBERSHIP TYPE _____________________ DATE JOINED ____________________________
SURNAME ____________________________________________________________________
(Mr/Mrs/Miss) (please circle) (or Business Name)  
FIRST NAME__________________________________________________________________
POSTAL ADDRESS_____________________________________________________________
STATE______________ POSTCODE________________
TELEPHONE HOME____________________ FAX___________________
EMAIL______________________________  
DATE PAID_____________________ AMOUNT___________________

** Membership subs due by June 30 each year **
Payment by cash, cheque or money order only, please.

FAMILY MEMBERSHIP: $25
SINGLE MEMBERSHIP: $20
PENSIONER/SENIOR: $15
covers single or couple

CHILDREN: $5

All members receive a free copy of the
Glen Innes & District Historical Society Inc. Bulletin
annually and copies of the quarterly Newsletter.