Upper Yarra Museum
PO Box 211 Yarra Junction 3797
03 59 672 167
www.upperyarramuseum.org.au
info@upperyarramuseum.org.au
Upper Yarra Valley Historical Society
(A0013059W)
Application for Membership
Please circle: RENEWAL (no changes; sign only) (RENEWAL: make changes and sign)
NEW: Complete form in full
Annual subscription: $20
YOUR NAME/ORGANISATION:…………………………………………………………………………………
ADDRESS:……………………………………………………………………………………………………………………
…………………………….Postcode:………………..
Phone…………………………AH…………………………….Mobile………………………………………………
email:……………………………………………………………………………………………
As a member of the Upper Yarra Valley Historical Society, I will respect the aims and
objectives of the Society as detailed in the UYVHS Rules. (Available on request)
Signature………………………………………Print Name………………………………Date.
Please return with payment to:
Treasurer, Upper Yarra Valley Historical Society, P.O Box 211, Yarra
Junction, 3797,
Upper Yarra Museum during opening times-Wed and Sun 11 to 4
Electronically to Upper Yarra Valley Historical Society Inc. Bendigo Bank,
Yarra Junction, BSB 633-000 Account-133640110
Please circle: receipt required-YES
NO
------------------------------------------------------------------------Office Use:
Approved………………
Signed ………………………………………………….
Action: ……………………………………………………………………………………………Paid:
Date approved………………………………….
UYVHS Membership form
Page 1
Monday, 27 May 2013