Application for Membership

I, .........................................................................................................................

of ........................................................................................................................

Tel: .....................................................................................

Fax: ....................................................................................

E-mail: ........................................................................

desire to become a member of The Bennelong Society

In the event of my admission as a member, I agree to be bound by the rules of the Association for the time being in force.

Signature of Applicant:.............................................................................  Date:..........................

I, .........................................................................................................................,

a member of The Bennelong Society, nominate the applicant for membership of the Society.

Signature of Proposer:.............................................................................  Date:..........................

I, ........................................................................................................................,

a member of The Bennelong Society, second the applicant for membership of the Society.

Signature of Seconder:.............................................................................  Date:..........................

Payment methods

1. Cheque enclosed for $ ...........................................    (Annual Subs $50)

Please make your cheque payable to 'The Bennelong Society, Inc'

OR

2. Inter-bank transfer:
The Bennelong Society Inc.
Westpac, 360 Collins St Melbourne
BSB: 033-000
A/c: 625116

(Please include your surname and initial in the reference line---otherwise we have no idea who has made the transfer.)

Please forward form (and cheque, if applicable) to:

The Bennelong Society, Inc.,
Level 2, 410 Collins St
Melbourne, VIC 3000