MEMBERSHIP FORM First Name(required) Surname(required) Street Address(required) Suburb(required) State(required) Postcode(required) Email(required) Telephone/Mobile Phone(required) Spouse/Children Name (children up to age 18 years can be included) Clan/Sept/Family Name Annual Subscription (1 July – 30 June) Please state – $15 SINGLE per annum OR $30 FAMILY per annum(required) Payment type – Please state – POSTED CHEQUE(required) PAYMENT CAN BE SENT BY CHEQUE – make payable to CLAN LAMONT Post to: Clan Lamont Treasurer 86 Bungay Road, Wingham, NSW, 2429 (Please include copy of Membership Form) Message Submit Share this:TwitterFacebookLike this:Like Loading...
