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Application for Membership Form
Asterisk (*) denotes a required field
I, (Full Name) *
Wish to :
I am a(n):
If a relative, please specify relationship: Eg: Son, daughter, wife, grandson, etc

Nominal Roll Details

of, (Full Name of member) *
Regimental Number *
Date of Birth
Date of Enlistment
Date of Discharge
If deceased, Date of Death
Posting on Discharge
Details of service: Please enter information such as overseas postings, unit served in, etc.
His name appears on the Nominal Roll of the Regiment *
I understand that I am bound by the rules and regulations, code of dress and conduct as set out by the executive from time to time *

Contact Details

Items marked "#" not for publication without permission
Title (Mr/Mrs/Ms/Sir/Mm...)
# Street Number & Name
# Town or Suburb
# Postcode
# Email Address *
Please note that an email address is required for contact purposes only and will NOT be made public.
# Mobile
# Phone