User account

Membership of the site is limited to members of the East Melbourne Historical Society. Use this form to apply for membership.
The membership fees for 2010 are $25 per person payable to the East Melbourne Historical Society Inc.
Members are entitled to participate in the functions and activities of the Society and have privileged access to certain information on the web site. (Guests are also welcome to functions, usually for a small additional fee.)

Username: *

Spaces are allowed; punctuation is not allowed except for periods, hyphens, and underscores.

E-mail address: *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Password: *

Confirm password: *

Provide a password for the new account in both fields.
This should be in the form: lowercase initials followed by four digit membership number.

Family name: *

Given name: *

Title:

Title as preferred by member.

Initials:

Name suffix:

Name suffix as preferred by member.

Postal address: *

Street or post office address for delivery of newsletters and notices.

Postal suburb: *

Suburb or post office for delivery of newsletters and notices.

State: *

Postcode: *

Street address:

Residential street address, if not same as postal address.

Suburb:

Residential suburb if not the same as postal suburb.

Phone:

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East Melbourne Historical Society

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