Please print, fill out, and senD

to 22 Victory Blvd, Ashburton VIC 3147

MEMBERSHIP FORM

 Yes! I want to be a part of  the Call of Guadalupe musical in promoting life and hope!

 

NAME _____________________        ______________________

            Family name                           First name

ADDRESS  _________________________________________________________

                   

            _________________________________________      __________

            City/Suburb                                                                Postcode

 

            ________________________         ___________________________

            Phone                                            Mobile

 

            __________________________________________________

            E-mail address

 

I wish to become a  member of “Friends of Call of Guadalupe"for 2017 - 2018 for $45.00 (Full price), $35.00 (Concession)

(Membership fee includes performance insurance, trainings and refreshments, admin etc.)

 

I,..................................................................... hereby apply for membership of the Association. Upon acceptance as a member by the Management Committee I agree to be bound by the Spirit and Rules of The Association.

 

Signature................................................    Date................................

 

Membership and Production Fee for cast 2017/2018: $45.00 (Full price),  $35.00 (Concession)

(Membership fee includes performance insurance, trainings and refreshments ,admin etc.)

 

If difficulty paying, contact one of the leaders as a payment plan may be implemented

 

Receipt No..............................(Office use only) 

I also want to make a Donation (tax-deductible) of  $20  $50  $75  $100 or (other) $.........

Receipt No..............................(Office use only)

 

Please circle the  method of payment:

Cash     Cheque    Master Card      Visa    Bank Card    Money Order

Name on Card................................................ Signature..................................................

Card Number_ _ _ _/ _ _ _ _/ _ _ _ _/ _ _ _ _ Expiry Date............./ .............

 

Total Payment (Membership and Donation) $...............

(A receipt will be mailed to you)

Please post to us at: 22 Victory Blvd, Ashburton VIC 3147

Office use only:

AMOUNT RECEIVED: ________________________ CASH   CHEQUE    CREDIT CARD   MONEY ORDER

 

Authorisation provided by Friends of COG-Melbourne Inc. No. A0046098R, ABN 96 857 733 724