AJGS New Member Form

Australian Jewish Genealogy Society Inc
ABN: 95 225 473 428

Name*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone

Optional; Please include area code

Mobile Phone Number*

Please enter a valid phone number.

Email*

example@example.com

MEMBERSHIP FEES (Please select your preferred membership)*

$20 Concession/ Student Membership$35 Single Membership$40 Family Membership

Please list the names of your family members

PAYMENT METHOD (Please select your preference for further details)*

Direct Debit/ Bank TransferCredit/ Debit Card

DIRECT DEBIT/ BANK TRANSFER

BSB: 633 000

Account No: 158979559

Account Name: Australian Jewish Genealogical Society Inc.

Please include your surname in the notes field of your deposit, then email the payment receipt to treasurer@ajgs.org.au

CREDIT/ DEBIT CARD PAYMENT

Concession/ Student Membership

$20.00AUD

Single Membership

$35.00AUD

Family Membership

$40.00AUD

Total

$0.00AUD

Date

Date Joined

AJGS MEMBERSHIP FORM