APPLICATION FOR MEMBERSHIP: MELROSE HOUSE CLUB Mail this form to: Melrose House Museum 275 Jacob Mar� Street Pretoria 0002 South Africa.
1. INDIVIDUAL
Title, Initials & Surname:
Postal Address:
E-mail Address:
Telephone:
Fax:
Cellular Phone:
Donation Enclosed:	R
Signature
Date:
2. INSTITUTION
Name:
Postal Address:
E-mail Address:
Contact:
Telephone:
Fax:
Cellular Phone:
Donation Enclosed:	R
Signature
Date: