Leave this field blank Name of Membership Group Address where group meets Suburb Postcode Postal Address for group Suburb Postcode Email address for Group Note: This is the email address which will be used for contact purposes by Victorian Quilters Inc. Name of President Phone Number Email address Name of Secretary Phone Number Email address Main Contact Name Main Contact Phone Number Does your group have a social media page or website? For example, Facebook or Instagram? Yes No Please provide the link here: https:// Are you planning on taking out insurance through Victorian Quilters Inc.? Yes No The insurance broker needs a breakdown of the ages of the members in your group. Please advise details below. How many of your members are aged : Under 18 Aged 18 - 74 Aged 75 - 84 Over 85 How many Members do you have in total in your Group? 1 - 25 26 - 50 51 - 100 101 - 200 201 - 300 301 - 400 401 & over Payment for New Group Membership is $85. This includes a $60 Annual Fee and a $25 joining fee. Please send payment of $85 using one of the options below. The Annual Fee for a Group Membership with 1 - 25 members is $375, which is made up of the following: $60 membership; $25 joining fee; $110 insurance; $180 insurance processing fee. The Annual Fee for a Group Membership with 26 - 50 members is $425, made up of the following: $60 membership; $25 joining fee; $160 insurance; $180 insurance processing fee. The Annual Fee for a Group Membership with 51 - 100 members is $555, made up of the following: $60 membership; $25 joining fee; $290 insurance; $180 insurance processing fee. The Annual Fee for a Group Membership with 101 - 200 members is $705, made up of the following: $60 membership; $25 joining fee; $440 insurance; $180 insurance processing fee. The Annnual Fee for a Group Membership with 201 - 300 members is $760, made up of the following: $60 membership; $25 joining fee; $495 insurance; $180 insurance processing fee. The Annual Fee for a Group Membership with 301 - 400 members is $855, made up of the following: $60 membership; $25 joining fee; $590 insurance; $180 insurance processing fee. The Annual Fee for a Group Membership with 401 + members is $915, made up of the following: $60 membership; $25 joining fee; $650 insurance; $180 insurance processing fee. Please deposit payment to :Victorian Quilters Inc.BSB 033 180A/C 302487For the Reference, please use Your Group Name.Once payment is made, send an email to insurance@victorianquilters.org with the acknowledgement number. This information will be included in the email you receive after submission of this form. Our group is able to sell a book of 10 Raffle tickets @ $2 each for the Showcase Raffle Quilt. YES NO Please notify Victorian Quilters Inc. of any changes to the above details using the Changes to Group Membership form on the website (under the 'Membership' tab). Once your form is submitted, you will receive an email to the groups email address named above, with payment details for your reference. Validate your submission Submit
