Membership Application – Qld Quilters Inc

Membership Form: Individual Membership Application

1st April 2022 to 31st March 2023
Please complete this form to renew your membership of Queensland Quilters.

Name *

First Name

Last *

Last Name

Address *

Address

City

State/Province

Zip/Postal

Country

Email *

Please enter your email address

Membership Number

Phone Number

Type Number including area code, without any spaces: 0712345678

Mobile

Type all numbers without spaces: 0421345678

Art Union Tickets

Each member will be sent Art Union tickets to sell (each book has 10 tickets at $2 each

Number of Books you would like to sell

Membership Fees: Full year Membership to 31st March 2023

Members *

Renewal Member: $50 Subscription to 31 March 2023

New and Non-Financial Member: $55 Subscription to 31 March 2023

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 *