<p> PO Box 324 Flinders Lane Melbourne 8009 Ph. 9658 9976 / Fax. 9658 8840 email: [email protected] ABN: 57399 480 298</p><p>Membership Form / Tax Invoice </p><p>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.</p><p>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 □</p><p>Contact Details Payment method First name Last name (tick ONE)</p><p>Position Visa BankCard Organisation MasterCard Cheque Mail address Cash EFT EFT No. / Date Suburb State P'stcode</p><p>Tel (W) Tel (H)</p><p>Mobile Fax</p><p>Email Web</p><p>Tick this box if you DO NOT wish to receive our regular bulletins of events, opportunities & other info</p><p>Tick this box if you DO NOT wish your email contact details to be shared with other members </p><p>Credit Card Details Name (that appears on card)</p><p>Credit card number Signature</p><p>Expiry date x...... </p><p>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.</p><p>Mail this form, with your remittance, to: Cultural Development Network PO Box 324 Flinders Lane, Victoria Vic 8009</p><p>Or save in Word and email to [email protected] or fax to 03 9658 8840. </p><p>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]</p><p>FEEDBACK FROM MEMBERS</p><p>We would be pleased to have your feedback about the Network’s operations and activities to help us with future planning. </p><p>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</p><p>□ other: please specify ………………………………………….</p><p>Is there anything you would like to tell us about your reasons for not renewing your membership?</p><p>______</p><p>______</p><p>______</p><p>Is there anything you would like to see the Network being involved in that is new or different from our current activities ?</p><p>______</p><p>______</p><p>______</p><p>Name: (optional) ______</p><p>Thankyou for your valuable feedback</p><p>Kim Dunphy Manager</p><p>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]</p>