Application Form for Single or Joint Membership

Application Form for Single or Joint Membership
The Society of Mountain Artists is based in the Blue Mountains, West of Sydney, in Australia.

PLEASE DO NOT CONSIDER APPLYING FOR MEMBERSHIP IF YOU DO NOT LIVE IN AUSTRALIA.
I/We are applying for:*

Single Membership, $40Joint membership, $70
Name*

First NameLast Name
Name 2*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Postcode
E-mail
Phone Number

Area CodePhone Number
Mobile
How did you hear about the Society?
What media do you work in and/or what areas would you be interested in exploring?
Promotion of Members' Artworks.

We like to use our members' artworks on our website and facebook page and to promote the Society and its' artists. Please indicate below whether you will permit this. Full copyright credit is given to the artist on any image that is used.
You may use images uploaded to my Gallery page*

YesNoNot applicable - no Gallery page
Newsletter. Please send my newsletter by:*

EmailPost - extra $15
Constitution:

The Constitution of the Society can be found here
Payment Options:
- Cheque: send cheque to Society of Mountain Artists at PO Box 76, Wentworth Falls, NSW 2782. Cheque payable to Society of Mountain Artists Inc.
- Cash: Pay the Treasurer at any monthly meeting
- Direct Debit: SMA BSB: 633000, A/C No.: 149824328. Your reference shouid be of the form SMA1+your initials+your surname (ie: SMA1jfcitizen for John F Citizen)
Select Payment Option:*

ChequeCashDirect Debit
Amount Due: $40
Amount Due: $70
Amount Due: $55
Amount Due: $85
Should be Empty: