Application for Branch Membership

Title:....................................................................

Surname: .............................................................

First name: ...........................................................

Residential Address:

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Postal Address (if different):

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Post code............

Phone:  Work:.......................... Home ...........................

            Mobile:............................

          Email:........................................

If NZSG member your no:  ...........................

Signature .....................................................

Date                  /           /

Annual membership fees 2011/12:

Single  $25     -     Couple  $40  -   Newsletter only  $5

Make cheques payable to ‘Kilbirnie Branch NZSG’ and hand to Treasurer at meetings; or post to Treasurer Kilbirnie NZSG, 29 Carlton St, Lyall Bay 6023

• For more information Contact : Secretary Kilbirnie Branch NZSG - Beverley Keall, 17/36 Dee St, Island Bay, Wellington 6023

• Phone: 04 9721508

• Email:kilbirnie@genealogy.org.nz