www.vadea.org.

au

2014 Membership Form

MEMBERSHIP TYPE
Concession

EARLY BIRD (before 31/3/13)

$15

STANDARD (after 1/4/14)

$30

Individual

$80

$100

2 4 educators

$200

$220

5 or more educators

$240

$270

*The Early Bird offer is valid until 31 March 2014.

st

st

(Membership valid 1 Jan 31 December 2014).

Member details:
For Institutional memberships please provide name and email address for each member (see reverse
side) who will be covered by the membership.

Mr/ Ms/ Dr: ______ Name: _____________________________________NSWIT No________________

Position / Department: __________________________________________________________
School / Educational Institution: __________________________________________________
Level:

Primary

Secondary

Tertiary

Pre-service teacher

Institute Type:
DEC

CEO

AIS

University

Gallery/ Museum

Others - Please specify: ____________________________________________________________

Institute Demographic:
Greater Sydney:
Eastern Suburbs

Regional NSW:

Mailing Address:

North Shore

Upper North Shore

Southern Suburbs

Northern NSW

Home

Inner West

South West Syd.

Southern NSW

Nth W. Syd

Western NSW

Work

Street______________________________________________________________________
Suburb_____________________________________State_________Postcode __________
Phone (work)_______________________________ Fax (work)________________________
Phone (home)________________________Phone (mob) _____________________________
Email
Please include my email address in the VADEA E-News list.

Name: _________________________________________________________________NSWIT No______________

Email

Name: __________________________________________________________________NSWIT No______________

Email

Name: __________________________________________________________________NSWIT No______________

Email

Name: __________________________________________________________________NSWIT No______________

Email

Name: __________________________________________________________________NSWIT No______________

Email

Name: __________________________________________________________________ NSWIT No______________

Email

Payment method:
Cheque

Money Order

Credit Card

Please make cheques payable to Visual Arts and Design Educators Association (NSW).

Card type:

Visa

Mastercard

Credit card number:

___ ___ ___ ___

___ ___ ___ ___

___ ___ ___ ___

___ ___ ___ ___

Cardholders name: ______________________________________________________

Valid to: _____ / ______

Signature: _______________________Amount:$____________

Complete all details & return with payment to:

VADEA NSW C/- PTC NSW PO Box 577 Leichhardt NSW 2040
Ph: 02 9716 0378 Fax: 02 9564 2342 email: vadea.admin@ptc.nsw.edu.au
When this amount has been paid in full, this form becomes a Tax invoice.
A receipt of payment will be issued with a membership number and a membership card for each member.
Please keep this number filed, to quote as needed for VADEA events.
ABN 21 386 957 963 (not registered for GST