New Customer Registration Form

2024-25 Membership form

1 Chapple Street, Gympie QLD 4570
Member type*

NewExisting
Select membership*

$40 for a single person$50 for two persons at the same mailing address
Full name*

First NameLast Name
Full name of second person

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

PostcodeCountry
E-mail*
example@example.com
Phone number*
Mobile or land line
Method of payment*

Online bankEFTPOSCash
Payment methods

Pay by bank deposit

Bendigo Bank BSB 633-000

Account number 164520546

Refereence MBR - (Name)
Or pay in person
We accept cash and EFTPOS payments at the office during opening hours.
Signature*

I/We hereby apply for new membership or membership renewal of the Gympie Family History Society to 31st August 2025 and agree to be bound by the rules of the Society.
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Use your mouse to draw your signature
_____________________________________________________

Office use only
Receipt
Date paid
Added to mailing list

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2024-25 Membership form