QUEENSLAND NAVAL BRIGADE, HISTORICAL ASSOCIATION
SOUTHPORT VOLUNTEER COMPANY, INCORPORATED
MF 1998                                MEMBERSHIP FORM                     NUMBER.....................
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PERSONAL DETAILS

GIVEN NAME.................................SURNAME......................................................

ADDRESS............................................................................................................................................................
....................................................................POST CODE...........................
TELEPHONE (WORK).........................................................
TELEPHONE (HOME).........................................................
TELEPHONE (MOBILE).....................................................
FAX...................................... DATE OF BIRTH................................................
        OCCUPATION....................................................
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*NOMINATED BY.........................................NUMBER..................................................
*SECONDED BY............................................NUMBER.................................................

APPLICANTS SIGNATURE...............................................DATE.......................
*must be a financial member of the association
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PREVIOUS MILITARY SERVICE

BRANCH.............................................................................
SERVICE NUMBER..........................................RANK..................................
DATE OF ENLISTMENT.................................TO...........................................
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OFFICE USE ONLY
DATE JOINED............/......./.............MEMBER NUMBER.........................................
MEMBERSHIP FEE PAID........YES..........NO.          AMOUNT $.....................
RECEIPT NUMBER..........................................
COMPANY SECRETARY....................................................
"F" FULL MEMBER.                           "A"   ASSOCIATE MEMBER.
        "HO" HONORARY OFFICER.                 "HM" HONORARY MEMBER.