Darwin Defenders 1942-45 Inc

To apply for membership of the Darwin Defenders association, please print this page, complete the form and send it (with your membership fee) to the Honorary Secretary at the address shown below.

To the Secretary,
Darwin Defenders 1942-45 Inc
73 Bay Shore Avenue
Clifton Springs,
Victoria, Australia 3222

I hereby make application for membership of Darwin Defenders 1942-45 Inc and I understand that this application form will go to the Management Committee for ratification.

Last name: ………………………………………….

First names: ………………………………………….

Preferred name: ………………………………………….

Address: ………………………………………….

Town or city: ………………………………………….

State: ………………………………………….

Postcode: ………………………………………….

Phone number: ………………………………………….

Date of application: ………………………………………….

Army / Navy / Air Force Unit (if applicable): ………………………………………….

Annual subscription fee (A$20.00) attached herewith.

Signature of applicant: ………………………………………….

OFFICE USE ONLY:

Proposed by: ………………………………………….

Seconded by: ………………………………………….

Date admitted: ………………………………………….

Subs paid [ ] Database [ ]

Mailing [ ] Badge issued [ ]