NOMINATION AND MEMBERSHIP APPLICATION
To apply for membership, either contact the Secretary for a Nomination and Application Form or print this page, complete the details and mail to:
The Secretary
Ceramics and Glass Circle of Australia Inc.
P.O. Box 1243
Hawksburn
Victoria 3142
Australia
E-mail: info@ceramicsglasscircleaustralia.org
PERSONAL DETAILS
| NAME: | ................................................................................ |
| TITLE GIVEN INITIAL SURNAME | |
| ADDRESS: | ................................................................................ |
| ................................................................................ | |
| ................................................. Post Code ................. | |
| TELEPHONE: | ................................................................................ |
| E-MAIL ADDRESS: | ................................................................................ |
| (OPTIONAL) |
Please note that personal details are treated as confidential and are not passed on to anyone outside the organisation.
INTERESTS AND INVOLVEMENT
Please indicate your areas of interest and involvement:
| Collector | ( ) |
| Glass Maker | ( ) |
| Ceramicist | ( ) |
| Dealer | ( ) |
| Curator | ( ) |
| Other (please give details) | ( ) |
| .................................................................. |
SIGNATURES
Membership is by nomination only (this is to maintain security)
I wish to apply for membership of the Ceramics and Glass Circle of Australia Incorporated and agree to be bound by the rules of membership
| Applicant: | .............................................................. |
| Proposer: | .............................................................. |
| Seconder: | .............................................................. |
(Note: Both the Proposer and Seconder must be current members of the Circle.
If this is not possible then please supply two references for review by the committee)
FEE
I enclose a cheque for $(A) ............, comprising of:
| Joining Fee | $10.00 |
| ............................... Membership | $ ........... |
| Donation | $ ........... |
| ________ | |
| Total | $ ........... |
Make cheques payable to "Ceramics and Glass Circle of Australia"
Separate donations of $(A)2.00 or more should be made payable to the "Ceramics and Glass Circle Cultural Fund" and are tax deductible for Australian taxpayers.