NAME: ____________________________________________________ D.O.B: *___ /___ /_______
HOME ADDRESS: _______________________________________________________P/C_______
POSTAL ADDRESS: ______________________________________________________ P/C_______
PHONE: (H) _____________________________ (W)___________________________
(Mob) ____________________EMAIL ______________________________________
User Group or Company name (If applicable)____________________________________
*DOB only required for Applicants under 18 years.
SIGNATURE: _____________________________________
Membership Fee
FULL YEAR – $5.00 (1st July to 30th June each year)
Membership Fee can be paid by EFT – LPM HALL, BSB 085 745, A/C No. 508113938 with reference of your surname and first initial, or by cash to the Secretary.
PLEASE RETURN THIS FORM WITH YOUR PAYMENT TO THE SECRETARY, PO Box 439, LITTLEHAMPTON SA 5250 or email to: secretary@littlehamptonhall.org.au
Any Member of the Public, over 15 years of age, may join the Littlehampton Peace Memorial Hall Association by completing and submitting the written application form and paying the prescribed fee.
By joining this Association, you agree to abide by the Constitution of the Littlehampton Peace Memorial Hall Inc.
