Fees:
Single Membership*       $25.00
Dual Membership*         $40.00
Joining Fee                     $5.00
* Includes our quarterly newsletter, Wattle Bark, posted to your address.

Surname:	Given Name(s):
Address:	Town:
State:	Post Code:
Telephone:  (        )	E-Mail:

Please note that membership lists are made available to other members of our Group.

Insert X for privacy                                                     


Please complete and return this form, together with your application fee, to.                    

The Secretary
Maryborough Family History Group Inc.
P.O. Box 59
Maryborough 3465
Victoria