Membership Application/Renewal Form

Membership Application / Renewal

To apply for membership please complete all questions.
Name*

First NameFamily Name
Address

Street Address

Street Address Line 2

Town State

Post Code
E-mail*
example@example.com
Mobile Number*
Format: 0000- 000-000.
Landline Number
Format: (00) 0000-0000.
Working with Children

Please note: if you are working in a production with persons aged under 18, and are 18 or more, you must have a current Working with Children Check, which if free for volunteers. (apply online at https://www.kidsguardian.nsw.gov.au and complete before submitting this form )
WWC Number
Expiry Date of WWC
Date of Application*

DayMonthYear
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To pay for membership: BSB 882000 Account No.9041134 Name: Bathurst Theatre Company

Please ensure that you include your name and membership type
Membership Types
prevnext( X )
Adult Membership
In part / fulltime employment

$30



Concessional Membership
Student / Senior / Not in Paid work

$15



Family Membership
(Adults and children living in same household)

$45
Should be Empty:

Membership Application / Renewal