C/- City of Melbourne

PO Box 324 Flinders Lane Melbourne 8009 Ph. 9658 9976 / Fax. 9658 8840 email: [email protected] ABN: 57399 480 298

Membership Form / Tax Invoice

I support the purposes of the Cultural Development Network Inc and wish to be: □ accepted as a member □ renew my membership I agree to be bound by the organisation's rules. Enclosed is my annual fee.

Fee Schedule Date Full Fee Concession* Application is (tick ONE) * Concession price is available for student, pensioners and others on low income including artists New and New and renewing renewing members $44 □ members $22 □

Contact Details Payment method First name Last name (tick ONE)

Position Visa BankCard Organisation MasterCard Cheque Mail address Cash EFT EFT No. / Date Suburb State P'stcode

Tel (W) Tel (H)

Mobile Fax

Email Web

Tick this box if you DO NOT wish to receive our regular bulletins of events, opportunities & other info

Tick this box if you DO NOT wish your email contact details to be shared with other members

Credit Card Details Name (that appears on card)

Credit card number Signature

Expiry date x......

EFT PAYMENTS: bank account details Cultural Development Network Inc BSB 083 004 A/C 55 3306 894 This form can be treated as an INVOICE and upon completion, as a RECEIPT. Unless you specifically request it, no other paperwork will be issued.

Mail this form, with your remittance, to: Cultural Development Network PO Box 324 Flinders Lane, Victoria Vic 8009

Or save in Word and email to [email protected] or fax to 03 9658 8840.

Our rules are available from our website http://www.culturaldevelopment.net PO Box 324 Flinders Lane Victoria 8009 Ph. 9658 9976 Fax. 9658 8840 email: [email protected]

FEEDBACK FROM MEMBERS

We would be pleased to have your feedback about the Network’s operations and activities to help us with future planning.

Are you an: □ artist □ artsworker □ arts organization □ government worker: □ local government □ state government □ federal government area: □ arts and culture □ community services □ health □ planning □ other □ community sector worker: area: □ arts and culture □ community services □ health □ welfare □ other

□ other: please specify ………………………………………….

Is there anything you would like to tell us about your reasons for not renewing your membership?

______

Is there anything you would like to see the Network being involved in that is new or different from our current activities ?

______

Name: (optional) ______

Thankyou for your valuable feedback

Kim Dunphy Manager

Please return this form to the Network by Post: Cultural Development Network PO Box 324, Flinders Lane Melbourne Vic 8009 Fax: 03 9658 8840 Email: [email protected]