Theatre Organ Society of Australia(Victorian Division) Inc
Membership Application
Print out this form, (A4 paper size), fill in all the relevant details in block letters, and post to:
Theatre Organ Society
P.O. Box 5013
HUGHESDALE VIC 3166
Theatre Organ Society of AustraliaMembership Application
Print out this form, (A4 paper size), fill in all the relevant details in block letters, and post to:
Theatre Organ Society
P.O. Box 5013
HUGHESDALE VIC 3166
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PERSONAL PARTICULARS Mr, Mrs, Miss, Ms (etc) Initials________ Surname____________________________ Given Names_________________________ Address______________________________ ____________________________________ Post Code________ Phone___________________
Partners Name VOLUNTEER FOR ACTIVE SERVICE If you would like to assist the Society in any of the following ways, please tick the appropriate activity(ies): Organ maintenance and/or installation_____________________________ Contributing to the VOX_____________________ Helping with mailout of VOX________________ Concert Front of House_____________________ Concert production________________________
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Tick the applicable category below. Family (2 Adults) _________________________$55___ Single __________________________________$45___ Interstate Family__________________________$45___ Interstate Single __________________________$41___ Junior (under 21) __________________________$25___ METHODS OF PAYMENT
I enclose a cheque, payable to TOSA (Vic), for: or please debit Mastercard___ Visa___ Card Number ______ ______ ______ ______ Expiry Date__/__ Signature__________________
DIRECT DEBIT
BSB - 063 001
Account Number - 0094 6256
Description on Direct Debit - ____________________
Is there any other way you could play an active role? ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ |