Launceston Historical Society Inc. 

Bringing together people with an interest in history

Application for Membership 

Subscriptions are for twelve months and apply from 
31 December each year.

PLEASE PRINT or RETURN BY EMAIL
 New Membership	OR	  Renewing Membership

  Name/s …………………………………………………………………….…….…………………………………
  Postal Address	……………….…
  ………………………………………………………………………………………………………….…………....
  Phone Numbers	……………….…
  Email Address…………………………………………………………………………….………………….…...
   	 Single			$25 	 Family	         	   $40 
 	 Concession      	$20 	 Concession family     $35
  	 Student	 	$10            Corporate               $50   
  
Membership Payment Details:     Cash      Cheque
 Direct Payment to BSB 067 003 A.C No. 2804 8638 (include name in reference field)
  
Date…..……..….…                    Membership fee $………………..

Post to:  The Treasurer LHS PO Box 1296 LAUNCESTON TAS 7250 
OR Email to: launcestonhistory@gmail.com
Website: launcestonhistory.org.au      Facebook: launcestonhistory
                          Receipt No: