March 2008 - The Danish Club in Brisbane, Australia

Application for Membership to
THE DANISH ASSOCIATION "HEIMDAL" Inc., BRISBANE
Applicant First Name, Surname
Occupation
Place of birth and/or connection with Denmark
Date of birth
Mobile Phone
Partner First Name, Surname
Occupation
Place of birth and/or connection with Denmark
Address – Street
Town / Suburb / Postcode
Date of birth
Mobile Phone
Home Phone
Fax
e-mail address
1, Childs Name Date of birth
2. Childs Name Date of birth
3. Childs Name Date of birth
4. Childs Name Date of birth
Hereby apply for admission as Fee per year tick one
Ordinary Member(s) receiving newsletter (must be of Danish $50.00
decent)
Associate Member(s) not receiving newsletter $25.00
Associate Member(s) receiving newsletter $50.00
Of the Danish Association "Heimdal" Inc. and if selected I (vi) promise to obey Rules and By-Laws.
I declare that the above information is correct.
(Signed) ................................................................................. ......................200…..........
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COMMITTEE's REMARKS
Proposer Seconder Date Accepted
Fee of $……..…Cash / Cheque
Paid on Recorded Receipt number
Please make cheques payable to "Heimdal" and post to:
Lone Lambourne
3 Dartmouth Court, Birkdale, QLD 4159
Ph (07) 3822 4476
E-mail: raylone@bigpond.net.au
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