Vadea Membership Form For 2010[1][1]

Visual Arts and Design Educators Association Membership Form Membership type: Concession

- $30 (Early Bird - $15)

Individual

- $120 (Early Bird - $100)

2 – 4 educators

- $200 (Early Bird - $180)

5 or more

- $250 (Early Bird - $220)

The early bird offer is open to those who register before the end of MARCH 2010

Member details: For Institutional memberships please provide name and email address for each member (see reverse side) who will be covered by the membership. Name: ______________________________________________________ Position / Department: _________________________________________ School / Educational Institution: __________________________________ ____________________________________________________________ Mailing Address: ______________________________________________ ____________________________________________________________ State _______________________________

Postcode __________

Phone (work)__________________________________ Phone (home__________________________________ Phone (mob) __________________________________ Fax__________________________________ Email_______________________________________________________ Please include my email address in the VADEA E-News list

Name: ______________________________________________________ Email_______________________________________________________ Name: ______________________________________________________ Email_______________________________________________________ Name ______________________________________________________ Email_______________________________________________________ Name ______________________________________________________ Email_______________________________________________________ Name ______________________________________________________ Email_______________________________________________________ Name ______________________________________________________ Email_______________________________________________________ Name ______________________________________________________ Email_______________________________________________________

Payment method: Cheque Money Order

Credit Card

Card type_______________________________ Valid to:

/

Credit card number: ___ ___ ___ ___

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Cardholder’s name ________________________________________ Signature ________________________________ Please make cheques payable to Visual Arts and Design Educators Association Complete all details & return with payment to: VADEA (Visual Arts and Design Education Association) PO Box 577 Leichhardt NSW 2040

When this amount has been paid in full, this form becomes a Tax invoice. A receipt of payment will be issued with a membership number. Please keep this filed, to quote as needed for VADEA events ABN 21 386 957 963 (not registered for GST)