City of Parramatta Art Society Inc.
 
                    147 George St. Parramatta  NSW  2150
                          Phone  (M)  0410 603 023
 
                        Application For Membership
 
Name      :________________________________________
 
Address  :________________________________________
 
               ________________________ Postcode_________
 
 
Phone     : ________________________________________
 
Email      :________________________________________
 
* I hearby apply to become a member of the City of Parramatta Art Society
* I agree to be bound by the rules of the society.
 
Signed       :_________________________________  Date :____________
 
 
    Membership Type for year   1st August 2011 to 31st July 2012
 
(     )  Exhibiting full membership               $40  Full year               $.............. Part year
(     ) Exhibiting Associate membership     $10  Full year               $..............  Part year
 with full paying member spouse/partner
(    ) Non exhibiting social member           $10  Full year               $..............  Part year  
 
Office use only    (      )  Fees received              Date : ________    Init. : _______
 
                          (      )  Entered into data base  Date : _________   Init : _______