Membership Renewal Form

Name

First

Last

Tick appropriate box:

Mr
Mrs
Ms
Miss

Address

Address Line 1

City

State / Province / Region

Postal Code

Home Phone

Mobile

Work Phone

Email

RENEWAL FEE: Members must be over 18 years (please tick appropriate category)

ADULT $30
FAMILY $35

Payment Details:

I enclose Cheque/Money Order of $30 (for single membership) payable to Maitland Region Society of Artists Inc.
We enclose Cheque/Money Order of $35 (for a family membership) payable to Maitland Region Society of Artists Inc.
Electronic Transfer: BSB: 650 000 Account No: 958126306. ACCOUNT NAME: Maitland Region Society of Artists Inc. Please include your name in bank transfer.
I will make a cash payment directly to Jenny Dimmock. 46 Bowden Street, Heddon Greta 2321

If you are paying by Electronic Deposit kindly email Jenny proof of payment. Please include date of payment made plus reference your name, plus MEM. e.g. K.Green MEM

Please tick the box if you'd like a receipt to be emailed to you.

Email

Maitland Regional Society of Artists