Art Gallery Society of New South Wales
Membership application form
Please complete, print and sign this form and mail or fax it to:
Membership Services Coordinator, Art Gallery Society of NSW, Art Gallery Road, Sydney NSW 2000
Fax: (02) 9225 1644 Tel: (02) 9225 1878
Top of Form
I wish to
Join
Re-join -- my old membership number was:
Buy a gift membership -- gift card message should read:
Art Gallery Society membership
1 year
3 years
Individual member
$95
$270
Joint members: 2 adults at same address
$140
$380
Household: 2 adults + 2 children under 18 at same address
$160
$435
Under 30s (please provide your date of birth)
$75
N/A
Full-time student (please provide photocopy of student ID)
$50
N/A
Concession: pensioner, veteran, Centrelink (please provide CRN)
$75
N/A
Country individual member: living 80km from Sydney
$90
$245
Country joint members: living 80km from Sydney
$110
$300
Country household: 2 adults + 2 children living 80km from Sydney
$140
$390
Overseas individual member
$155
$440
Overseas joint members
$175
$495
Overseas Household members
$205
$585
Premier individual member
$250
$675
Premier joint members
$320
$865
Includes GST and registration fee Three-year membership fees are non-refundable.
I would also like to receive e-newsletters.
New member details
1. Mr / Ms / Mrs / Dr (please circle) or Other:
Name(s): 2. Mr / Ms / Mrs / Dr (please circle) or Other:
Name(s): (Please include given names)
Address:
Suburb: State: Postcode:
Phone: Mobile:
Email address:
Date of birth: / /
Gift purchaser details (if applicable)
1. Mr / Ms / Mrs / Dr(please circle) or Other:
Name(s): (Please include given name)
Date of birth: / /
2. Mr / Ms / Mrs / Dr (please circle) or Other:
Name(s): (Please include given name)
Date of birth: / /
Address:
Suburb: State: Postcode:
Phone: Mobile:
Email address:
Postage details
Please send the new membership to: gift purchaser new member
By / / Allow up to 14 days for delivery or call (02) 9225 1878 for urgent gifts
Please send future membership renewals: gift purchaser member
My payment details
You may send a cheque made out to the Art Gallery Society of NSW OR pay by credit card. Fill in your card details below.
To make next year's renewal easy and receive a one-off $10 discount, opt for our automatic direct debit renewal. Simply deduct $10 from the total, tick 'YES' and sign the automatic direct debit authorisation at the bottom of this page (only for automatic direct debit).
Total payment: $
Payment type: cheque credit card
Please charge my:
Mastercard Visa American Express
Card number:
Expiry date:
Card name:
Signature of cardholder: __________________________________
Date:
Yes, I __________________________________ (signature) authorise for all future renewals to be charged as they fall due to the credit card on this form. I may cancel this agreement at any time. Direct debit is not available for under 30s, student or concession memberships.