A00 by lonyoo

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									                                   APPLICATION FOR MEMBERSHIP
                                    WOMEN’S ART REGISTER INC.

        Representing over 2000 Australian based women artists in 20,000 slides and 2000
                             information folders, CDs and books

Membership:
Individual Membership              $35.00
Concessional Member                $25.00
Institution Member                 $55.00
International Member               $45.00
Credit card surcharge              $2.00
Costs of submitting Slides/ CD’s (Two sets required)
Member rate- 24 slides (plus duplicates) or 1 CD (plus duplicate)      $10.00
Member rate- next 24 slides (plus duplicates) or 1 CD (plus duplicate) $5.00
Non-member rate - 24 slides (plus duplicates) or 1 CD (plus duplicate) $45.00
Non-member rate - 24 slides (plus duplicates) or 1 CD (plus duplicate) $25.00

Membership of contributing artists is appreciated, but not required.


NAME: ---------------------------------------------------------------------------------------------------------------

ADDRESS: ----------------------------------------------------------------------------------------------------------

STATE/POST CODE: ---------------------------------------------------------------------------------------------

EMAIL:--------------------------------------------------------------

SIGNATURE: --------------------------------------------------
                                                                               DATE:

PH:                       FX:
artist                  admin/curator           educator                 supporter               other

PLEASE FIND ENCLOSED PAYMENT FOR:

      Placing slides /CD on the Register                       $

      Membership (see above)                                   $

      Donation to Register                                     $

      Other (please specify)                                   $

      Credit Card Surcharge ($2-)                              $
                                              TOTAL            $


     method of payment         cheque       money order                           credit card
Note a $2 surcharge applies for Credit card payments

CREDIT CARD                      Visa                          Mastercard



SIGNATURE:                                                         EXPIRY DATE:


OFFICE USE ONLY
 funds processed  receipt number                                  receipt sent          computer entry

forms/appform 2006
TO LODGE SLIDES AND/OR DOCUMENTS WITH THE WOMEN’S ART
REGISTER FILL IN THE ATTACHED FORMS AND RETURN TO:


Women’s Art Register Inc                             Please print clearly:
415 Church Street
Richmond 3121                                        Your Name: --------------------------
VIC                                                  Address: ------------------------------
                                                     City:------------------------------------
ph: 0424 333 136                                     State/postcode -----------------------
email: womensartregister@yahoo.com                   ph: --------------------------------------
Web www.womensartregister.org                        fax: -------------------------------------
                                                     email: ----------------------------------




CHECKLIST

Before sending your application/slides/documentation, use this checklist to make sure
you have completed everything



                    2 copies of each slide/CD
                    All slides marked and numbered
                    Slide list completed
                    2 copies of the documentation
                    Fee calculated and payment enclosed
                    Copies made for your own records
                    Agreement form signed




forms/appform 2006

								
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