| First Name | Surname | ||
| K-CHS Member | Address only required if changed | ||
|
Street or POB
|
City/Suburb
|
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|
State
|
Postcode
|
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| Phone | Mobile | ||
| Enter 'None' if you have no email address | |||
| Note (optional) | |||
|
Year of Birth (req'd for insurance) |
Millstone by post as well as by email |
||
| Second person (for family membership) | |||
| First Name | Surname | ||
| Year of Birth | Mobile * | ||
| email * | * only if different from first person | ||
| Single Adult Membership | @ $20 ea | ||
| Family Membership | @ $30 /family | ||
| Single Senior Membership (70 and over) | @ $12.5 ea | ||
| Senior Family Membership (either over 70) | @ $15 /family | ||
| K-CHS is not registered for GST | TOTAL | ||