Brisbane History Group: Membership

To nominate for membership of the BHG simply print out this page and forward it to:

                 The Secretary
                 Brisbane History Group Inc
                 PO Box 12
                 Kelvin Grove DC QLD  4059
                 Australia

Preferred Title   ____ (Mr, Mrs, Ms, Dr)

Given Names       _____________________________ (Please PRINT)

Family or Surname _____________________________ (Please PRINT)

Mailing Address   _____________________________ (Please PRINT)
                  _____________________________
                  _____________________________


Business Address  _____________________________
                  _____________________________
                  _____________________________


Telephone         (night)(___)_____________________

                  (day)	(___)_____________________

                  (fax)  (___)_____________________


E-mail (if applicable) ____________________________

My Interests in Brisbane History are

              _______________                 ______________
              __________________________                 ___
              ___________                 __________________
              ____________                 _________________  

I/We do/do not wish to receive newsletters by e-mail.

I/We do/do not wish to receive notice of other societies' events by e-mail. (Sometimes, after our newsletter has gone to print, we receive details of other societies' events which will take place before our next newsletter is published.)

I/We enclose the following:

  Individual rate	[ ]

  Group rate		 [ ]                  $_________


 Signature