TITLE (Mr., Mrs., Ms. Miss, Dr., etc):
NAME:
ADDRESS:
POSTCODE:
PHONE: FAX:
Email:
Date:
I, hereby apply for membership of the Australian Lebanese Historical Society and agree to abide by the rules of the Society.
Signature of Applicant:
Joining Fee ............................ $25 Annual Membership Fee ........ $25 Donation ....................... Total .............................
Please make cheques payable to Australian Lebanese Historical Society and post application to: