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 172
Southland Centre
CHELTENHAM VIC 3192
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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 (Mr. & Mrs, incl children under 16)_____$50___ Single_________________________________$40___ Country or Interstate Family________________$40___ Country or Interstate Single_________________$36___ Junior (under16)__________________________$20___ 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? ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ |