www.vadea.org.

au

2013 Membership Form

ABN 21 386 957 963 (not registered for GST)

Membership type
Concession

- $30 (Early Bird - $15)

Individual

- $120 (Early Bird - $100)

2 4 educators

- $200 (Early Bird - $180)

5 or more

- $250 (Early Bird - $220)

The Early Bird offer is valid until 29 March 2013. (Membership valid from Jan - Dec 2013).

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: __________________________________________________

Position / Department: _____________________________________________________
School / Educational Institution: _____________________________________________
Level:

Primary

Secondary

Tertiary

Institute Type:
DEC

CEO

AIS

University

Gallery/ Museum

Others - Please specify:____________________________________________________

Institute Demographic:
Greater Sydney:
Eastern Suburbs

Regional NSW:

North Shore

Upper North Shore

Southern Suburbs

Northern NSW

Inner West

South West Syd.

Southern NSW

Nth W. Syd

Western NSW

Mailing Address:
Home
Work
_________________________________________________________________________
Suburb____________________________________ State________Postcode _________
Phone (work)________________________________ Fax (work)_____________________
Phone (home)_____________________ ___Phone (mob) __________________________
Email

Please include my email address in the VADEA E-News list.

Name: ____________________________________________________________________________________
Email

Name: ____________________________________________________________________________________
Email

Name: ____________________________________________________________________________________
Email

Name: ____________________________________________________________________________________
Email

Name: ____________________________________________________________________________________
Email

Name: ____________________________________________________________________________________
Email

Payment method:
Cheque
Card type:

Money Order
Visa

Credit Card

Mastercard

Credit card number:

___ ___ ___ ___

___ ___ ___ ___

___ ___ ___ ___

___ ___ ___ ___

Cardholders name: ______________________________________________

Valid to: _____ / ______

Signature: _______________________________

Please make cheques payable to Visual Arts and Design Educators Association (NSW).
Complete all details & return with payment to:
VADEA NSW
C/o PTC NSW
PO Box 577 Leichhardt NSW 2040
Ph: 02 95643322
Fax: 02 9564 2342 email: 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).