American Civil War Round Table of Australia New South Wales Chapter (an incorporated association)

Program Director: John Cook Tel: 02 9412 3214
Secretary/Treasurer: Brendan O'Connell Tel 02 9449 3720
Website: www.americancivilwar.asn.au
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Membership Application Form

To: Secretary
American Civil War Roundtable of Australia
P O Box 200
St. Ives NSW 2075

I wish to join the American Civil War Round Table of Australia (NSW Chapter) Inc.
(NSW Incorporated association number: INC9882123)

I live in the Sydney metropolitan area and enclose a cheque for $40* payable to ACWRTA.

Address _________________________________________________________________

______________________________________________________ Postcode: __________

Telephone ( ____ ) ______________

Mobile: ______________________

Email: ___________________________@_________________________
Please print carefully

Signed: ____________________________ Date _______________ 20__

* The membership fee for those living outside the Sydney metropolitan area is $35.00