MEMBERSHIP APPLICATION

Details of Applicant

First Name ……………………………………… Surname ………………………………………

Postal Address……………………………………………………………………………………….……

Phone …………………………………………. Fax …………………………………

Email ……………………………………………………………………….…………

Year graduated from Bridgetown High School ……………………………………          

Type of Membership Applied for (please tick box); The Foundation Life Members will not only receive life membership, but also have their names listed on an honour board at the school and receive a unique life membership badge.

 Ordinary annual membership                                               $30

 Corporate annual membership                                             $50

 Foundation Life Member                                                      $300

 Cheque enclosed                                  OR             Please charge to my credit card listed below:

Type of card…………………………………….

Card number……………………………………………………………………. Expiry Date……………

Name on card…………………………………………………………………

Security number ………………………………(last three numbers after card number on the BACK of the card)

Chairman: Barry Mackinnon; Secretary: Jeff Hollands; Treasurer: Bronwyn Macneil

Committee Members: Robyn McSweeney, Scott Robinson, Adrian Elder, ............ Stacey Nicolaou,.Julia Phillips, Lyn Whitney, Dave Wood.