HR Nicholls Society

Application for E-mail Membership

Please note that applications for membership require approval by the Board of the HR Nicholls Society. We will inform you of the status of your application as soon as possible.

Personal Details
Name:*
Address 1:*
Address 2:*
Address 3:
Address 4:
State:*
Postcode:*
Phone:
Fax:
Mobile:
Occupation:*
Email:*

Supporting Material (please fill in A or B) A. The following two members of the H R Nicholls Society have agreed to support my nomination:
Nominator:*
Seconder:*
B. my interest in labour market reform is as follows:
Interest:

Fees and Remittance
Joining Fee:	$30
Email Subscription Fee:*	$50 for one year
Additional Sum:	$ I enclose this additional sum to assist the work of the Society.
TOTAL:*	$ I will forward this amount to H R Nicholls Society Inc
Payment Method:*	This is how I will forward payment. For electronic remittances, the Society's account is: Bank of Melbourne, 360 Collins Street, Melbourne, 3000 The H R Nicholls Society Inc, 033-000 69-7304 Payment by cheque should be posted to: The Treasurer The H R Nicholls Society Inc 64 Greig Street, ALBERT PARK, Vic 3206

Choice of Tie or Scarf
Gift:*

Agreement:*	In the event of my admission as a member, I agree to be bound by the rules of the Society from this time: 06 Feb 12

Why HR Nicholls?

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