Widgee District Hall & Recreation Association Inc.

Membership Application

 Date: _________________

ÿ  Voting Membership           $22.00

ÿ  Social Membership           $11.00

 Membership Details

 First Name: _________________________  Surname: ______________________________

 Address: ___________________________________________________________________

 Phone or Mobile: ___________________  Email: __________________________________

 Nominated By: ________________________________   Membership No. ______________

 Seconded By: __________________________________  Membership No. ______________

 Acceptance

 Meeting Date: _________________               New Membership No. ______________

 Comments: _________________________________________________________________