Membership Form: Affiliated Group Membership Application Membership Form: Affiliated Group Membership Application 1st April 2019 to 31st March 2020 Please complete this form to join or to renew your group membership of Queensland Quilters. Group Name * Contact Person * Contact Position * Email * Please enter your email address Address * City * State * QLD NSW Postal Code * Membership Number Phone Number Type Number including area code, without any spaces: 0712345678 Mobile Type all numbers without spaces: 0421345678 Meeting Details Time * 121234567891011 : 0030 AMPM Day of the week/month * Please indicate second Tuesday each month, for example Venue * Address * City * Postal Code * Section New members * We welcome new members We cannot accept new members We agree to have our details circulated to other groups / quilters/ appropriate businesses * YES NO Art Union Tickets We agree to sell Queensland Quilters Inc. Art Union tickets. Number of books of tickets we can sell (10 tickets per book) Number of Books you would like to sell * Membership Fees: Full year Membership to 31st March 2020 Affiliated Group Members * Financial Member: $60 New or Non-Financial Member: $65 Payment Amount $ Payment You can make payment by Direct Deposit to Queensland Quilters OR by Credit Card Direct Deposit Name of Account: Queensland Quilters Inc BSB: 034-002 Account Number: 768617 Please include your last name and membership number as the payment reference. Credit Card Please contact Verna Hunt with your credit card details. Mobile: 0409 062 485 Signature * Clear Date * Submit If you are human, leave this field blank.