New Group Membership Application Form Leave this field blank Name of Membership Group Address where group meets Suburb Postcode Postal Address for group Suburb Postcode Name of President Phone Number Email address Name of Secretary Phone Number Email address Main Contact Name Main Contact Phone Number Email address for Group 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 $180, which includes a base annual fee of $60 and a joining fee of $25. The Annual Fee for a Group Membership with 26 - 50 members is $225, which includes a base annual fee of $60 and a joining fee of $25. The Annual Fee for a Group Membership with 51 - 100 members is $335, which includes a base annual fee of $60 and a joining fee of $25. The Annual Fee for a Group Membership with 101 - 200 members is $465, which includes a base annual fee of $60 and a joining fee of $25. The Annnual Fee for a Group Membership with 201 - 300 members is $515, which includes a base annual fee of $60 and a joining fee of $25. The Annual Fee for a Group Membership with 301 - 400 members is $595, which includes a base annual fee of $60 and a joining fee of $25. The Annual Fee for a Group Membership with 401 + members is $645, which includes a base annual fee of $60 and a joining fee of $25. Will you be sending payment by cheque or bank transfer? Cheque Bank transfer Please send cheque made payable to Victorian Quilters Inc. to:Victorian Quilters Inc.c/- 5 Robinson Rd,Kooroocheang VIC 3364with your Group name in a letter, or a copy of the pdf you will receive after submitting this form. Please deposit to :Victorian Quilters Inc.BSB 033 180A/C 302487For the Reference, please use Your Group Name 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 Contact form on the website. Validate your submission
