Clone of SEA membership form 18+

Member details
Name

Full Name
Date of Birth

DayMonthYear
Date
Name of Workshops
Phone Number
Please enter a valid phone number.Format: 0000-000-000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you consent to SEA publishing your image in SEA photos or video
Relevant Physical, Medical or Behavioural Information
Please include details and how our teaching artists can provide support
Emergency Contact Details
Name

Full Name
Relationship
Phone Number
Please enter a valid phone number.Format: 0000-000-000.
Payments

MEMBERSHIP FEE of $20 ($15 for additional family members) each calendar year is due at time of application.

WORKSHOP FEES are due at the beginning of each term and must be received no later than week 3. Payments are accepted via: Online booking, EFTPOS, cash, & direct debit (as below)

Direct debit details: (BSB: 633 000 | ACC: 130 294 770)
Membership Payments
How would you like to pay your membership fee
How did you pay your membership fee?

First Membership

to be paid each calendar year

$20.00 AUD Quantity

Additional Family Membership

$15.00 AUD Quantity

Total

SEA members are entitled to voting privileges at our Annual General Meeting each year. Parents/guardians may elect to vote on behalf of their minor. By signing up as a member of SEA you are agreeing to:

- Adhere to our Constitution (available to download on our website).

- Adhere to our member Code of Conduct and Policies.

- Your email address being added to our Newsletter database (you can unsubscribe at any time).

-Photos or video footage being taken of members and used on the SEA website, Youtube, Vimeo, Facebook and other third party websites to promote the work of SEA and our funding bodies unless opted out above.
In order for SEA to deliver culturally relevant and accessible programs, please indicate if you would like to identify as:
To Sign Print Participant Full Name

First NameLast Name
Date Signed

DayMonthYear
Date
Should be Empty:

Member details