VADEA 2013 Membership Form
Transcript of VADEA 2013 Membership Form
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www.vadea.org.au
2013 Membership FormABN 21 386 957 963 (not registered for GST)
Membership type
Concession - $30 (Early Bird - $15)
Individual - $120 (Early Bird - $100)
2 4 educators - $200 (Early Bird - $180)
5 or more - $250 (Early Bird - $220)
The Early Bird offer is valid until 29 March 2013.(Membership valid from Jan - Dec 2013).
Member details:
ForInstitutional memberships please provide name and email address foreach member(seereverse side) who will be covered by the membership.
Mr/ Ms/ Dr: ______Name: __________________________________________________
Position / Department: _____________________________________________________
School / Educational Institution:_____________________________________________
Level: Primary Secondary Tertiary
Institute Type:
DEC CEO AIS University Gallery/ Museum
Others - Please specify:____________________________________________________
Institute Demographic:
Greater Sydney: North Shore Upper North Shore Inner West
Eastern Suburbs Southern Suburbs South West Syd. Nth W. Syd
RegionalNSW: Northern NSW Southern NSW Western NSW
Mailing Address: Home Work_________________________________________________________________________
Suburb____________________________________ State________Postcode_________
Phone (work)________________________________Fax (work)_____________________
Phone (home)_____________________ ___Phone (mob)__________________________
Email
Please include my email address in the VADEA E-News list.
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Name: ____________________________________________________________________________________
Email
Name: ____________________________________________________________________________________
Email
Name: ____________________________________________________________________________________
Email
Name: ____________________________________________________________________________________
Email
Name: ____________________________________________________________________________________
Email
Name: ____________________________________________________________________________________
Email
Payment method:
Cheque Money Order Credit Card
Card type: Visa MastercardCredit card number:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Cardholders name: ______________________________________________
Valid to: _____ / ______ Signature: _______________________________
Please make cheques payable to Visual Arts and Design Educators Association (NSW).
When this amount has been paid in full, this form becomes a Tax invoice . A receipt of payment willbe issued with a membership number and a membership card for each member. Please keep this numberfiled, to quote as needed for VADEA events. ABN 21 386 957 963 (not registered for GST).
Complete all details & return with payment to:VADEA NSW C/o PTC NSW PO Box 577 Leichhardt NSW 2040Ph: 02 95643322 Fax: 02 9564 2342 email: [email protected]