MEMBERSHIP APPLICATION/RENEWAL FORM

(Please print, fill in and mail - details at bottom of page)

New membership is $20.00 per person
Renewal is $10 per annum

Current membership is over 200 - Our success relies on your support!

Renewal ($10) __ New member ($20) __
Owner __ Builder __ Trade __ Patron __ Architect __ Other __
(please tick where applicable)

Name .............................................

Street/PO Box ...............................................................

Suburb .................................

P/Code .................................

Ph/Fax ..................................

Mobile ..................................

Email .............................................

Cheques payable to:
Nillumbik Mudbrick Association
PO Box 385, Eltham, Vic, 3095

Receipts will not be posted unless requested