Membership Application | Queensland Quilters

Membership Form: Individual Membership Application

1st April 2018 to 31st March 2019
Please complete this form to renew your membership of Queensland Quilters.

If you are human, leave this field blank.

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

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

Date *

Signature *

Members *

New and Non-Financial Member: $55 Subscription to 31 March 2019

Payment Amount $

Payment Method *