WAC  MEMBERSHIP APPLICATION

 

 

NAME:

 

 

 

 

Mr/Mrs/Ms/Miss

Given Names

Surname

 

ADDRESS:

 

 

 

 

 

POSTCODE:

 

TELEPHONE:

(H)

 

 

(M)

 

 

(B)

 

 

 

EMAIL:

 

 

 

 (To receive newsletter)

 

 

 

PLEASE TICK APPROPRIATE BOXES:

 

 

PAYMENT TYPE:

ANNUAL RENEWAL             NEW MEMBER

 

Annual membership runs calendar year from January – December

AMOUNT:

(including GST)

Single               $50.00

Family              $60.00  - Additional Names: …………………………………………………….

Pensioner        $35.00  - Pension Number:  ……………………………………….……………

Regional          $25.00  - 70 km outside of Sydney

WAC Teacher  $25.00

 

Donation      $_____            Amounts over $2 tax deductible. A receipt will be issued.

 

Total                       $_____

 

PAYMENT BY:

Cash   Cheque/Money Order   Credit Card – Mastercard   Visa   Bankcard

 

Fill in if posting form

Name on Card

 

Fill in if posting form

Card Number

_ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _

Expiry date

_ _ / _ _

Required

SIGNATURE:

 

 

DATE:

 

 

As the Workshop relies on volunteers to support the activities that take place during the year, your participation would be very welcome. Please indicate in which areas you would be able to help.

 

Administration/Office 

Hanging Exhibitions        

Archives      

Fundraising                 

Building Maintenance     

Mailouts      

Market Day                 

Clean Up Day                  

Other           

 

Office Use Only

$50.00 – Single Membership

 

Receipt Number

 

$60.00 – Family Membership

 

Added to Mailing List

 

$35.00 – Pensioner

 

Letter & Card Sent

 

$25.00 – Regional

 

Receipt Sent for Donation

 

$25.00 – WAC Teacher