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Nannup Historical Society Inc
Application for Research
Formal research by the society attracts a $15 fee payable with this application form. Additional research fees are negotiable with the Society
Delivery Address
First Name
*
Surname
*
Street Address
*
Address Line 2
City
*
State
*
Post Code
*
Phone Number
Email Address
*
Description of research required
Please state the nature of the research required, for example family, buildings, events
*
If a person or family member is to be researched please fill in the details below
Surname
Given Names
Date of birth
Date of death
Please include any other relevant details of the person to be researched
Billing Address
An initial fee of $15 (in advance) will be charged, with further research charges by arrangement
Billing Address
Same as Delivery Address
First Name
Last Name
Street Address
Address Line 2
City
State
Post Code
Payment
By Credit Card
Credit Card Type
*
Visa
MasterCard
American Express
Discover
Name on Card
*
Credit Card Number
*
Expiration Date
*
Security Code
*
By Direct Debit
Please send remittance by EFT to Nannup Historical Society Inc, BSB 066508, Account 10141053 and include you name as the reference.
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