Contact Us

abn 90 393 792 173

application for membership / membership renewal

application / renewal:(please circle one)

SURNAME:
GIVEN Name

address
postcode

PHONE No (H)
Mobile

email:

For new members only – your application must be endorsed by an existing member:

Current Member Name & Signature:

payment

Please enclose $40.00 either by cheque or direct transfer being for the annual subscription. Please post this application form to the above address or email it to Enquiries@helleniclyceum.com.au

I would like to pay by
chequeDIRECT TRANSFER (Please use your name as reference)

AMOUNT: $40.00

Bank: Delphi Bank

BSB: 941-203

Account Number: 203227020

Account Name: Hellenic Lyceum

date of transfer

date
signature

Download Form

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