Join the Society:
Membership Form

PHS Membership Application Form

The Secretary,
Puhoi Historical Society Inc.,
P.O. Box 404-224, Puhoi 0951

To apply to become a member of the Puhoi Historical Society
please fill out and send the form below.

* First name: * Surname:
2nd First name:
Associated with Puhoi family name...:
Address:
* Email: * Phone:
Member type: (Select one)     Individual $15  Family $30   Life $150  Message Only
Type any comments or messages here:

* Required fields must be completed
Would you like to be contaced by email?: (Select one)     Yes  No
NOTE:   The personal details you have supplied above are for use by the Puhoi Historical Society only and
will not be passed on to third parties.
PAYMENT: An invoice will be sent to your above address. Your application be processed when payment is received.

Click "Save Target As" to download the Membership Form as a PDF

Click "Save Target As" to download the Membership Form as a Word document