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:..........................

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

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

Please forward cheque and form to:

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