Hardys Bay Residents Group Inc

                            New Members Application

Please print and complete the form below,
attach annual membership fees of:
$10 per person or $15 per family (pensioners half price)
and post to:

The Secretary,
Hardys Bay Residents Group
PO Box 4123
Wagstaffe NSW 2257

     Name:      ____________________________________________________________

        Address: ____________________________________________________________

                          _____________________________________________________________

       Email:       _____________________________________________________________

       Phone:     _______________________   Mobile: ______________________________

        Signature:___________________________________ Date: ___________________