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Name: ………………………………………………………………………………………………………
Residential Address: …………………………………………………………………………………………
Postal Address: ……………………………………………………………………………………………..
…………………………………………..Postcode………………….Telephone
(……)…………………….
Please find enclosed:
Cheque (payable to Clunes Museum) Money order for $…………
Forward completed order form to : Clunes Museum
Mail to:
Robert Campbell
36 Fraser St
Clunes Victoria 3370
Australia
PHONE/FAX:
03 5345 3082
(A.B.N. 76 845 763 535)
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