Canberra Quilters Inc Membership

Application Date

Date

Membership type*

Membership number

Name*

First NameLast Name

Email*

example@example.com

My contact details have changed (for new members contact details must be entered)*

YesNo

Address

Street Address

Street Address Line 2

CityState

Postcode

Phone Number

Mobile Number

I wish to order a name badge*

YesNo

If you order a name badge the cost is $15 plus $4 postage. Please remember to select name badge (and postage if required) when filling out the Membership payment options below. Please note your badge will NOT be ordered until payment is made.

Please print my name on the badge as shown here:

Badge Name

Membership comments/questions?

Fee Schedule:

Annual membership is for one calendar year (1 January – 31 December)
Membership must be paid before midnight on the first Thursday of February to qualify to exhibit or sell at the CQ Annual Exhibition.

Accepted Methods of Payment on-line:

Credit/debit card
Direct deposit

Please bear in mind that any card payment involves a fee paid to the payment processor, so a direct deposit is preferred if possible, however if you select that option, please include your name and "Membership" on the payment description so our treasurer can correctly identify the payment.

Membership payment options (please select all options required, including name badge if ordered)*

Total payment

Card payment

Payment by credit/debit card or direct deposit*

CardDirect Deposit

Direct Deposit: either through a Commonwealth Bank branch or online directly from your account. (Please make sure you include your name, membership number and reason for payment on the transaction.)

BSB: 062 909 Account Number: 00901010

For card payment only, if direct deposit just click "Submit"

AUDDescription

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration