Associate Membership Application

Membership Fee*

1 year (A$50 +$5) 3 year (A$150 +$5)

Title

Family name*

Given name*

Occupation

Residential address*

City*

Postcode*

Telephone*

Business/postal address

Postcode

Telephone

Mobile

Email*

Date of birth*

dd/mm/yyyy

Proposer

Proposer No.

Seconder

Seconder No.

I hereby apply to become a member of the New South Wales Masonic Club, declare that I am over the age of 18 years and agree to abide by the rules and laws of the Club.

How did you hear about the New South Wales Masonic Club?

Referral Magazine Internet Other

Special interests

Print form to be faxed or mailed with cheque payment..

Pay by credit card online.

Online payments accept Visa, Mastercard and Bankcard only. For payment by Diners Club or AMEX please contact the membership office - 61 2 9284 1006

Masonic and Masonic Un-attached — please use the Masonic Application Form or contact the Club for further information. Phone: 61 2 9284 1006 or email admin@nswmasonicclub.com.au

* Fields marked with asterisk are compulsory.