Theatre Organ Society of Australia  -  Membership Application

(South Australian Division) Inc.

 

Surname [1]: Mr/Mrs/Miss/Ms/Dr…………………………………………………………………………….

 

Given name: ………………………………Preferred name (for badge etc) ……………………………......

.

Address: …………………………………………………………………………………………………..........

 

……..………………………………………....................................... Post code: ………………………….

 

Phone No: Home: …...…………………………………..Work: ………………..…………………………

.

 

E-mail: ……………………………………………………………………………………………………………

 

Surname [2]: Mr/Mrs/Miss/Ms/Dr …………………………………………………………………………….

 

Given name: ………………………………Preferred name (for badge etc) …………………………………
 

 

Phone No: Work: …………………………………………….

 

 

 E-mail: …………………………………………………………………………………………………………...

 

 

Enclosed is a cheque/money order for $ ______ (Australian dollars) for the following membership

or complete details below for credit card:

NOTE:

 

Fees include GST for Australian residents.

 

N.B. Fees as at

May, 2013

 

New financial year starts July 1st.

 

Name

on card:…………………………………………….. Signature: …………………………….Expiry date:        /    

Print this page and post the above form with fee to:

Membership Secretary, TOSA (S.A. Div.) Inc. PO Box 307

GOODWOOD SA 5034 AUSTRALIA

¨ Free Club Nights, on the second Monday  each month, which are mainly entertainment.

¨ Discounts to TOSA concerts.

¨ Discounts to film sessions at the Capri Theatre.

¨ Monthly newsletter with theatre organ news, concert reviews etc..

¨ The privilege of playing on our theatre organ.

Full Membership Benefits

TOSA banner

Category

Cost

Amount

Remitted

Family

$72

$

Pensioner Double

$46

$

Single

$52

$

Pensioner Single

$35

$

Single Parent Family

$56

$

Full-time Student

$27

$

Distant (Australia)

$32

$

Overseas

$30

$

Overseas Airmail, add

$27

$

Joining Fee for all

$16

$ 16

Total Enclosed [Must include Joining Fee]

 

$.

Card No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of credit card

 

 

 MasterCard

 

 

 

 

 

 Visa