Friends of Black Rock House Membership Form

Membership fees are $20 for families and $15 for individuals per annum. 

Please complete the form below. Once completed please pay your membership fee as follows:

  • via EFT deposit to BSB 633000  A/c 165508284
  • by mailing your cheque made out to Friends of Black Rock House Inc to PO Box 200, Black Rock VIC 3193

Thank you - we look forward to welcoming you

NAME AND FAMILY DETAILS

For example Mr, Ms, Mrs, Miss, Dr

Family membership only:

PHONE AND EMAIL

ADDRESS

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