THE AUSTRALIAN BALLET SOCIETY INC
APPLICATION FOR MEMBERSHIP ~ 2009

The Australian Ballet Society Inc is based in Victoria and offers access to Dress Rehearsals and Functions in Melbourne. For NSW and SA see Friends of The Australian Ballet.

2009 MEMBERSHIPS AVAILABLE FROM NOVEMBER THIS YEAR

This is a:    RENEWAL [  ]    NEW APPLICATION [  ]   (Please tick)

Title:............Surname.....................................Given Name.........................................................
Address...........................................................................................................................................
Post Code....................Telephone: (H).........................................(B)......................................

[   ]    Adult $ 49.00
[   ]    Joint (2 Adults) $ 91.50
[   ]    Seniors (Seniors Card No: .........................................) $ 43.00
[   ]    Pensioner (Pension No. ...............................) $ 25.00
[   ]    Child / Student (Under 26 years - Student No. ..........................) $ 25.00
[   ]    Family (Parents and Children under 17 years)
Children: Names and Date of Birth ..............................................
.................................................................................................... 		$ 97.00
 

(Membership Fees include GST)

  
  Total for Membership    $ .............
  Donation to The Australian Ballet Society Fund*
(GST Not Applicable)		 $ .............
  Total Enclosed    $ .............

GIFT MEMBERSHIP DETAILS

Full name of recipient ....................................................................................................................

Address ........................................................................................................................................

Message on Gift Card ...................................................................................................................

......................................................................................................................................................

Payment by Cheque/Money Order [  ]    or Charge my BC [  ]  MC [  ]  VISA [  ]

Number:  /    /    /    /    /    /    /    /    /    /    /    /    /    /    /    /    /    EXPIRY DATE .........../.............

Name on Card ...................................................... Signature ...........................................

Please enclose a STAMPED SELF-ADDRESSED ENVELOPE
for return of your Membership Card

Address: Level 4/2 Kavanagh Street, SOUTHBANK, Vic. 3006. ABN 64 740 345 188.
Tel: (03) 9669 2860.  Fax: (03) 9682 7078.  e-mail: balletso@bigpond.net.au
Upon payment of the amount due this document will be a Tax Invoice.

* Donations of more than $2 to The Australian Ballet Society Fund are tax deductible and allocated to the Annual Scholarship funds provided by the Society to The Australian Ballet School, as well as other special projects.