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
Premier Individual member
$249
$635
Premier Joint member
$322
$830
Individual member
$115
$293
Joint members: two adults at same address
$152
$393
Household: two adults and two children under 18 at same address
$175
$455
Country Individual member: living 80 km from Sydney
$100
$253
Country Joint members: living 80 km from Sydney
$124
$317
Country Household members: 2 adults + 2 children living 80 km from Sydney
$154
$388
Overseas Individual member
$165
$448
Overseas Joint members
$189
$512
Overseas Household members
$278
$583
Full-time student (please provide photocopy of student ID)
$75
N/A
(includes GST and registration fee) Three-year membership fees are non-refundable.
I would also like to receive the Contempo e-newsletter. More info
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 / / (Please 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 - please 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.) NOTE: Direct Debit is not available for Student Membership -- Full time ID must be proved at each renewal time.