Ozquilt Network 2020 Membership Form

Ozquilt Network Membership Form 2021
The membership year runs from 1 January-31 December 2021. All new and renewing members must complete an membership form regardless of method of payment.
Contact Details
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State

Post Code Country
Phone Number *

Area Code Phone Number
E-mail *
Status *

Renewal New Member
Check any information you DO NOT PERMIT Ozquilt Network to publish to other members

Name Street Suburb/Postcode Phone Email
Website
Blog
Facebook Artist Page
Instagram
Public accounts only please
I request official notices (eg notice of AGM) by e-mail only. *

Yes No
Membership Fee
Membership Fee *

Full member A$40 Student A$20
Payment by *

Direct Deposit/EFT Credit Card Cheque/Money Order
Payment by Credit Card
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OZQN Full membership 2021 $ 40.00 AUD

OZQN Student membership 2021 $ 20.00 AUD

Total $ 0.00 AUD
OZQN PREFERS PAYMENT BY DIRECT DEPOSIT BSB:033 602 Acct#:13 6213
(Please include your name and the letters “MBS” in transaction description).

Payment may also be made by:
- credit card (via PayPal) : no PayPal account required; OR
- cheque payable to Ozquilt Network Inc and mailed to PO Box 753 WANGARATTA VIC 3677.
Supporting Information
Age Range *

18-29 30-39 40-49 50-69 70+ Not specified
Arts Practice *

Textile or Quilt Artist - Experienced Textile or Quilt Artist - Developing Artist, non-textile Art Consultant Arts related business/worker Art Student Tutor/Lecturer Writer Curator Other
Many volunteers work together to make Ozquilt Network happen. Are you willing to assist in some way (eg exhibitions, functions, subcommittees, working parties)? *

Yes No
If yes, are there any special skills that you have that might be helpful to Ozquilt Network?
New Members: How did you hear about Ozquilt Network?
Comments
By submitting this form, I agree to be bound by the rules of Ozquilt Network Inc.
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Ozquilt Network Membership Form 2021