Application For Associate Membership - Port Phillip Pioneers Group

Application For Associate Membership of the Port Phillip Pioneers Group

If you would prefer to download, print and fill in the form instead of using the online form below, you can download it here. Postal and payment details are included on the form.

Application For Associate Membership

First Name

Last Name

My Contact Details

Address Line 1

Address Line 2

City

State

Postcode

Country

Phone No

I became aware of the Port Phillip Pioneers Group by:

I would like to become an associate member because:

I may be descended from a pioneer, but would like to join while investigating this further

I am not descended from a pioneer but am interested in the issues you deal with

Please send Pioneer Echo (our Newsletter) by:

Post

Subscription

1 Year: Newsletter Posted $30

1 Year: Newsletter Emailed $15

Payment by EFT to Port Phillip Pioneers Group Inc, BSB 633 000, a/c no. 178805867 (please identify with your surname and initials), or by cheque in favour of ‘Port Phillip Pioneers Group Inc’ posted to our Treasurer: Dean Wheeler, 21 Apex Ave, Hampton East, VIC 3188

I declare that the statements made by me are true and correct.

Application For Associate Membership of the Port Phillip Pioneers Group

My Contact Details

PORT PHILLIP PIONEERS GROUP INCORPORATED

Address

Contact Us