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EUREKA'S CHILDREN INC.
Membership Application/Renewal for 2016 (Jan-Dec)
Please print all details and
 where appropriate.
Surname:
Other Names:
Address:
Postcode:
Phone No
Email
Membership of Eureka's Children Inc. operates on a calendar year basis.

Member Subscription - descendants of those who were connected with the Stockade event, its prelude and its
aftermath.
Full $30.00 per annum

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*Concession $15.00 per annum
Associate Member Subscription - open to non- descendants with an interest in Eureka and its ideals of
democratic principles.
Full $30.00 per annum
*Concession $15.00 per annum
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

Family Membership Full
$30.00 +$20 = $50 per annum


Family M/ship Concession
$15.00 + $20= $35 per annum
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Note: Life Membership - Full $300, Concession $150
Note: Concessional Subscriptions include Pension Card Holders.
For Family Membership please list each other name and there contact detail (See over page)
All amounts include GST
An additional fee of $10 pa for overseas residents
$10

Donation welcome

$....................
Total Cheque/Money order
$.................
NOTE: EFT Payments can be made to: “Eurekas Children - (BSB)704191 (A/C)90789”
Please include Eurekas Children as well as your name on the internet transfer
………………………………………………………………………………………………………………………
Please print, complete this form and return with your cheque/money order to: Mr. Stephen Nolan
Treasurer, Eureka’s Children. C/O. Celtic Club 316-320 Queen St, Melb. Vic. 3000 Ph. 0417330883
If paying by EFT and you are a new member you would need to also complete and return this form as an
initial record of your membership.
OTHER IMMEDIATE FAMILY MEMBERS
Surname:
Other Names:
Address:
Postcode:
Phone No
Email
Surname:
Other Names:
Address:
Postcode:
Phone No
Email
Surname:
Other Names:
Address:
Postcode:
Phone No
Email
Surname:
Other Names:
Address:
Postcode:
Phone No
Email
Surname:
Other Names:
Address:
Postcode:
Phone No
Email