Visual Arts and Design Educators Association

Membership Form

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 open to those who register before the end of MARCH 2010

Member details:

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

Name: ______________________________________________________

Position / Department: _________________________________________

School / Educational Institution: __________________________________

____________________________________________________________

Mailing Address: ______________________________________________

____________________________________________________________

State _______________________________ Postcode __________

Phone (work)__________________________________

Phone (home__________________________________

Phone (mob) __________________________________

Fax__________________________________

Email_______________________________________________________

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

Name: ______________________________________________________

Email_______________________________________________________

Name: ______________________________________________________

Email_______________________________________________________

Name ______________________________________________________

Email_______________________________________________________

Name ______________________________________________________

Email_______________________________________________________

Name ______________________________________________________

Email_______________________________________________________

Name ______________________________________________________

Email_______________________________________________________

Name ______________________________________________________

Email_______________________________________________________

Payment method:

Cheque

Money Order

Credit Card

Card type_______________________________ Valid to: /

Credit card number:

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Cardholder’s name ________________________________________

Signature ________________________________

Please make cheques payable to Visual Arts and Design Educators Association

Complete all details & return with payment to:

VADEA (Visual Arts and Design Education Association)
PO Box 577 Leichhardt NSW 2040

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. Please keep this
filed, to quote as needed for VADEA events

ABN 21 386 957 963 (not registered for GST)