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 – BANK DEPOSIT or POSTED CHEQUE(required) PAYMENT CAN BE PAID via BANK DEPOSIT – CLAN LAMONT SOCIETY of AUSTRALIA Commonwealth Bank BSB 062623 ACCOUNT Number 10119701 Reference: 1st initial and surname + subs year (eg VCREED subs2019) ALTERNATIVELY, PAYMENT CAN BE SENT BY CHEQUE – make payable to CLAN LAMONT SOCIETY OF AUSTRALIA Post to: Clan Lamont Society Treasurer 86 Bungay Road, Wingham, NSW, 2429 (Please include copy of Membership Form) Message Submit Share this:TwitterFacebookLike this:Like Loading...
