7/30/2019 VADEA 2013 Membership Form
1/2
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.
7/30/2019 VADEA 2013 Membership Form
2/2
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]
