TOSA LogoTOSA Logo 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


PERSONAL PARTICULARS

Mr, Mrs, Miss, Ms (etc) Initials________

Surname____________________________

Given Names_________________________

Address______________________________

____________________________________

Post Code________

Phone___________________

Partners Name
(Family Membership ONLY)_________________

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________________________

Tick the applicable category below.

Family (Mr. & Mrs, incl children under 16)_____$55___

Single__________________________________$45___

Interstate Family_________________________$45___

Interstate Single__________________________$41___

Junior (under16)__________________________$25___

METHODS OF PAYMENT

I enclose a cheque, payable to the Theatre Organ Society, for:
$_________

or please debit Bankcard___ Mastercard___ Visa___

Card Number ______ ______ ______ ______

Expiry Date__/__ Signature__________________

Is there any other way you could play an active role?

____________________________________________

____________________________________________

____________________________________________

____________________________________________