Membership Year: 1 July ______ to 30 June 30 _________

Family name: Other names:

House name (if known) and address:

Telephone: Fax:

Please sign here:
Applicant/member: Date:

Introduced by:

Tick as required:	Please find enclosed
FULL RATE $25.00 PENSIONER/STUDENT $12.50 New Renewal	CASH CHEQUE (Please make payable to The Haberfield Association Inc) These annual fees include Newsletter delivery in Haberfield; for other areas, please add postage $2. Two-year membership payments are welcome.

Just by joining you add
support to our work in
the commnunity. Your
continuing member-
ship is important and
much appreciated. If
you would also like to
take a more active part,
or can help in other
ways, indicate here:

Family name:	Other names:
House name (if known) and address:
Telephone:	Fax:
Please sign here: Applicant/member:	Date:
Introduced by: