Membership BVHS

Cnr Stuart & Myokum Sts, Mullumbimby.
PO Box 378, Mullumbimby, NSW, 2482.

Phone: 02 6684 4367

I (full name of applicant)...*

First NameLast Name

...hereby apply to become a member of the Brunswick Valley Historical Society Incorporated Association. 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*

Please use your mouse on a desktop or finger on a mobile device to write a facsimile of your signature.

Date*

Today's date

I was nominated for membership of the BRUNSWICK VALLEY HISTORICAL SOCIETY INC. by the person known to me as listed below...

Name*

First NameLast Name

Annual Membership Fee*

Adults $15Concession $10

Membership includes newsletters but, because of increased mailing costs, if you require one by snail mail it is $5 extra. If you wish to receive a newsletter please ‘tick’ how you’d like to receive it:*

None at allBy emailPick up a copy from the MuseumPrinted mailed copy for $5/yr

If you are interested in participating at the Museum please complete the information below:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

Next of kin and contact number:

Occupation/Life situation

Do you have any health issues that could manifest while volunteering at the museum?

Do you have Ambulance cover?

Hobbies/Interests?

Why would you like to participate?

From this list please type your preferred activity below: Executive Position, Marketing, Secretarial, Oral History, Education, Exhibitions/Displays, Research, Building Maintenance, Guide Conservation, Acquisitioning, Publishing, Technology, Restoration, Markets, Data Entry, Front Desk, Machinery Shed, Events? Other?

Availability and hours: please type: weekly/fortnightly/monthly - what days Tuesday and/or Friday - what hours - or just for special events - or just on market days? Other choices?

New Member Information & Introduction sessions are held when necessary so come along and find out more about the activities available at the museum. Just come for a 10am start and a guided tour through the Museum. There will be plenty of opportunity for answers to all your questions regarding how you can contribute. For more details phone 02 6684 4367

Thank you for your enquiry and interest.

Please verify that you are human*

My Products*

AUDPlease enter the total of the fees that you have selected above.

Note: Because this form was made on a free public platform called Jotform - when you receive your email copy of your completed Application - it will have a small ad at the bottom with a button encouraging you to sign up and create your own forms - which you can just ignore - unless you have a need for online forms.

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

MUSEUM

APPLICATION FOR MEMBERSHIP