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]

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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.

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