HERITA HERITAGE FESTIVAL - NSW

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MEMBERSHIP APPLICATION MEMBERSHIP TYPE APPLICATION TYPE
MEMBERSHIP MEMBERSHIP Personal APPLICATION MEMBERSHIP TYPE
Personal TYPE APPLICATION TYPE
Gift From Gift From Phone ( )
Phone ( )
Personal Personal Gift – From Gift – From Phone (( ))
Phone ( )
Personal Member 1 Mr Member Mrs 1 Miss Mr Ms Mrs Dr DrMiss Ms Dr
Member 1 Gift – From Mr Member Mrs 1 Miss Mr Ms Mrs Dr DrMiss Ms Dr Phone ( )
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Name
Name
Surname
Surname
Member Name 1 Mr Mrs Name Miss Ms Surname Dr
Surname
MEMBERSHIP Member 2 APPLICATION Mr MEMBERSHIP Member Mrs 2 TYPE
Miss APPLICATION Mr Ms Mrs TYPE
Dr DrMiss Ms Dr
Name
Member 2 Mr Member Mrs 2 Miss Mr Ms Mrs Surname
Dr DrMiss Ms Dr
Name
Personal Name
Personal Gift – From Surname Gift – From Phone Surname
(( ))
Phone ( )
Name
Name
Surname
Surname
Member Member Address 2 1 Mr Mr Mrs Member Address
Mrs 1 Miss Miss Mr Ms Ms Mrs Dr
Dr DrMiss Ms Dr
Postcode
Postcode
Address
Address
Postcode
Postcode
Name
Name Phone (Daytime) ( ) Name Phone (Daytime) ( Email(s) )
Surname
Surname Email(s) / Surname
/
Phone (Daytime) (( )) Phone (Daytime) ( Email(s) ) Email(s) //
/
Address
Member Occupation(s) 2 Mr Member Occupation(s) Mrs / 2 Miss Mr Ms D.O.B(s) Mrs / Dr DrMiss Ms D.O.B(s) Dr Postcode
Phone (Daytime) Occupation(s) Occupation(s) // D.O.B(s) / D.O.B(s)
Name ( ) Name Email(s)
(Family Membership - - Up (Family to to 4 children Surname Membership under - 18. Up Please to 4 children Surname
list below) under 18. Please list below)
Occupation(s)
(Family Membership - - Up (Family to to 4 children Membership under - 18. Up Please to 4 children list below) under 18. Please list below)
Address Name(s)
Address
D.O.B(s)
Name(s)
D.O.B(s)
D.O.B(s)
Postcode
Postcode
Name(s) (Family Name(s) Membership - Up to 4 children D.O.B(s) under 18. Please list below) D.O.B(s)
MEMBERSHIP
Phone (Daytime) (
TYPE
( )) MEMBERSHIP
Phone
(Daytime) TYPE ( Email(s) )
10%
Email(s) //
/
Name(s)
MEMBERSHIP TYPE MEMBERSHIP
TYPE
10%
D.O.B(s)
Occupation(s) Occupation(s) (Joining // fee payable 1st (Joining year D.O.B(s)
/ only fee to payable to cover 1st administration year D.O.B(s) only to costs) cover administration costs)
(Joining fee payable 1st (Joining year only fee to payable to cover 1st administration year only to costs) cover administration costs)
MEMBERSHIP Individual
TYPE (GST (Family
Individual included. 1 year
Membership 3 year $65
membership - - Up (Family to to 4 3 children
1 years
Membership = 10% under $176 discount)
- 18. Up Please to 4 children list below) under 18. Please list below)
$176 $65 $181 3 years $181
Joint Name(s) Individual
Joint (2 (2 adults)
adults)
Name(s) Individual Joint (2 1 year adults) year
$95
$95
$65
$93 D.O.B(s)
1 3 years
1 years
$176
$257
$65 $181
$257 $93 $259
D.O.B(s) 3 years $181
(Joining 3 years $259
fee Joint payable (2 adults) 1st year only Joint to (2 cover adults) year administration $95
$93 costs)
1 years $257 $93 $259 3 years $259
Family MEMBERSHIP Family (2 adults, (2 adults, 4 TYPE
children)
4 children) MEMBERSHIP
Family (2 1 year
adults, TYPE 4 $95
$95 children) $93
31 years
10%
$275 $257 $93 $259 3 years $259
Individual Junior Family Individual (up (2 to adults, Concession 18 years)
4 children) Family 1 (2 adults, 4 $95
children) $93 1 $257 $93 $259 3 years $259
(Joining Individual 1
year fee year
$65 Concession payable $45
$35 $44 1st (Joining year only 3
3
1 fee years
year year to payable to cover $95
$176
$122 $44 $123
1st administration year 3 only years to costs) cover $123 administration costs)
Joint (2 Individual adults) Individual Joint Concession
Concession
ConcessionIndividual 1 Joint Concession 1 year Concession year $45
$95
year $68
$45 $44 1
$65 3 1 years
$122
year $122 $44 $123 $257 3 years $123
$184 $65 $181 3 years $181
Family (2 Joint Joint Individual adults, Concession
Concessions
4 children) Joint Individual Concession card No(s) Concession 1 1 year year $68
card No(s) $95 $75
$65 1 3 years
$184
$203 $176
$275 $65 $181
3 years $181
Junior (up Concession Joint to 18 (2 years) adults) card card No(s)
No(s) Concession Joint (2 card No(s)
1 1 year adults) year $35 $95
$93 1 3 years $257 $95 $93 $259 3 years $259
Membership Type Fee Membership (As listed above) Type Fee $ (As listed above) $
Individual Family Concession (2 adults, 4 children) Family (2 1 year adults, Type 4 $95
children) $93 Fee Membership (As 1 years Type $257 $93 $259
Fee (As 3 listed years above) $259
1 Membership year
Joining Fee
$45 Type Fee (As $30 or or $20
3 listed
Joining year above)
concession Fee
$122 $
$
Individual ConcessionIndividual $30 $ 33.00 or $20 concession $
1 Joining year Concession Fee $45
$44 $30 or or $20 31 years concession Fee $122 $44 $123 $30 33.00 or $20 3 years concession $123
Joint Concessions
Joining Fee $ 35.00
Donation 1 year ($2 $75 and over Donation tax 3 year deductible) ($2 $203
$
Joint Concession Joint and $ over tax deductible) $
Concession Donation 1 year ($2 $68
and $65 over is Donation tax 31 years deductible) deductable) ($2 $184 and $65 $181
$
over tax 3 years deductible) $181 $
Membership Total $ Membership Total $
Concession Concession card No(s)
card No(s) Concession card No(s)
Membership Total $
Membership Total $
(Community (Community Groups/Libraries/Company (Community Groups/Libraries/Company Memberships, phone (02) Memberships, 9258 0156)phone (02) 9258 0156)
(Community Groups/Libraries/Company Groups/Libraries/Company (Community Memberships, Groups/Libraries/Company Memberships, Phone: Type (02) Fee phone 9258 (As (02) 0156) Memberships, 9258 0156)phone (02) 9258 0156)
Membership Type Fee (As listed above) $ listed above) $
PAYMENT METHOD PAYMENT
Joining METHOD Fee $30
or or $20 Joining concession Fee $30 33.00 or $20 concession $
PAYMENT METHOD PAYMENT
METHOD
Joining Fee $ 35.00
Cheque/Money Order (Payable Cheque/Money Donation National ($2 Order and Trust (Payable over of of Donation tax Australia, deductible) National ($2 NSW) and Trust over of tax Australia, deductible) NSW) $
Cheque/Money Order (Payable Cheque/Money Donation – ($2 National and Order over Trust (Payable of of Australia, – National NSW) Trust of Australia, NSW)
Cash
Credit Card Credit Diners Card Master is Diners Membership tax deductable) Card Total $
Master Membership Visa Card Total $
Visa Amex
Amex
Cash
Credit Card Credit Diners Card Master Diners Card Master Visa Card Visa Amex
Amex
(Community Groups/Libraries/Company (Community Membership Groups/Libraries/Company Memberships, Total $ phone (02) Memberships, 9258 0156)phone (02) 9258 0156)
Credit Card No. Credit Card No.
(Community Credit Card No. Credit Card No.
PAYMENT Groups/Libraries/Company
Name on Card
METHOD PAYMENT Name
on Card METHOD Memberships,
Phone: (02) 9258 0156)
Name Cheque/Money Card
Order Name (Payable Cheque/Money Card
– National Order Trust (Payable of of Australia, – National NSW) Trust of Australia, NSW)
Expiry Date
Expiry Date
Signature
Signature
PAYMENT Expiry Cash
Credit Date
METHOD Card Expiry (Direct Credit Diners Date Debit Card available Signature
- Phone Master Diners 02 Card 9258 -0156) Signature Master Visa Card Visa Amex
Amex
Please automatically renew Please my automatically annual membership renew my via annual my credit membership card via my credit card
Please automatically renew Please my automatically annual membership renew my via annual my credit membership card via my credit card
Please Credit Please find enclosed Card fax No. the completed cheque/Money Credit Please form Card fax to Order to No. the (02) completed (payable 9252 1264 to form The mail to National (02) to: 9252 Trust 1264 NSW) or mail to:
Please fax the completed Please form fax to to the (02) completed 9252 1264 form mail to (02) to: 9252 1264 or mail to:
Membership, National Membership, Trust (NSW), National GPO Box 518, Trust Sydney (NSW), 2001 GPO Box 518, Sydney 2001
Cash Membership, Name on Card Visa National Membership, Name Trust Amex (NSW), on Card
National GPO Box Mastercard 518, Trust Sydney (NSW), 2001 GPO Box Diners 518, Club Sydney 2001
Special offer offer is is valid valid until until December Special 3rd offer 4th 2010. is 2009. valid Members Members until December and their and their friends 4th friends 2009. (referred Members (referred new members) and new their members) and friends all new and (referred all members all new new each members) receive each one and receive entry all new members each receiv
into Expiry
one the entry draw offer Date
into is for is valid valid
the a chance until draw until for for to December Special Expiry
a one win a chance entry this 3rd offer Date
holiday 4th
to 2010. into is
win
2009. valid
the Members to this Australia’s draw
Members until holiday for
December Signature
and a to Remote chance to their and Ireland. their friends 4th Corners. to friends
win
2009.
For (referred full this For Members (referred Signature
Special offer is valid until December 2nd 2011. Members and their friends (referred new members) details holiday full and new details all and members) to new and Ireland. conditions their members) and friends
For excluding all visit full new and (referred visit details www.nsw.nationaltrust.org.au
all junior members all www.nationaltrust.com.au
new members and new conditions each members) each receive recieve each
visit and one receive
www.nsw.nationaltrust.org.au
entry all new members each receive
into one the entry draw for into for a chance the a chance draw win for for this a one win a chance Quilty entry this Tour holiday to into win Australia’s the this Australia’s draw holiday Remote for a to Remote chance to Corners. Ireland. For Corners. to full win For details full this For details and holiday full conditions details and to Ireland. conditions visit www.nationaltrust.com.au
Card No. For visit full visit details www.nsw.nationaltrust.org.au
www.nationaltrust.com.au
Please automatically renew Please my automatically annual membership renew my via annual my credit membership card via my credit and card conditions Expiry visit www.nsw.nationaltrust.org.au
/
Images: Above: Old Government Images: House. Above: Photo Old by by Government Christopher House. Shain; Below: Photo by Everglades Christopher House Shain; and Below: Garden. Everglades Photo by by House Rachel and Brown. Garden. Photo by Rachel Br
Image: Please Face fax Painting the Images: completed at Norman Above: Please Old form Lindsay Government fax to to Gallery the (02) Images: completed House. 9252 (Photo: Above: Photo 1264 Christopher Old by form by Government Christopher mail Shain) (02) to:
House. Shain; 9252 Below: Photo 1264 by Everglades or Christopher mail to: House Shain; and Below: Garden. Everglades Photo by by House Rachel and Brown. Garden. Photo by Rachel Bro
Cardholders Name
Signature
Membership, National Membership, Trust (NSW), National GPO Box 518, Trust Sydney (NSW), 2001 GPO Box 518, Sydney 2001
Heritage Internal Please pages_Member awards_membership form_v1.indd 1
9/12/2009 11:16:34 Heritage awards_membership Special automatically
offer offer is Benefits_2.indd is valid valid renew
form_v1.indd until until December Special my 1 annual
1 3rd offer 4th 2010. is 2009. membership valid Members Members until December and their and via their my
friends 4th credit friends 2009. (referred card Members (referred new members) and new their members) and friends all new and (referred all members all new new each members) 1/12/2010
9/12/2009 receive each
11:16:34 one and 10:57:13 receive entry all new AMmembers each receiv
AM
into one the entry draw into for the a chance draw for for to a one win a chance entry this holiday to into win the to this Australia’s draw holiday for a to Remote chance to Ireland. Corners. to win For full this For details holiday full details and to Ireland. conditions For visit full visit details www.nsw.nationaltrust.org.au
www.nationaltrust.com.au
and conditions visit www.nsw.nationaltrust.org.au
Please fax the completed form to (02) 9252 1264
Images: Above: Old Government Images: House. Above: Photo Old by by Government Christopher House. Shain; Below: Photo by Everglades Christopher House Shain; and Below: Garden. Everglades Photo by by House Rachel and Brown. Garden. Photo by Rachel Br
or mail to: Membership, National Trust (NSW), GPO Box 518, Sydney 2001
or join online at www.nationaltrust.com.au
Heritage awards_membership form_v1.indd 1
9/12/2009 11:16:34 AM
Image: Face Painting at Norman Lindsay Gallery (Photo: Christopher Shain)
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