Wildlife Art Society of Australasia Inc.

Please print, then fill in the details, and send with cheque or postal order by post to:

The Secretary
PO Box 284
Canterbury Victoria Australia 3126

ADULTJUNIORNON-EXHIBITING MEMBER*
JOINING FEE$5.00$2.50$5.00
ANNUAL SUB.$60.00$22.50$40.00
TOTAL$65.00$25.00$45.00

PLEASE PRINT NEATLY
Name: ______________________________________ Title: Mr. Mrs. Miss. Ms. Dr.
Street Address: _______________________________________________________________________
City: _________________________
State: _________________________
Postal Code: __________
Home phone:______________________ Fax: ______________________
Business hours:______________________ Mobile: ______________________
Email Address: _______________________________________________________________________
Web page: _______________________________________________________________________


I wish to become a Member/Junior Member of the Wildlife Art Society
of Australasia Incorporated and agree to abide by the rules of the Society.

I enclose a cheque/money order for the amount of $................
to cover the Joining Fee and Annual Subscription.

Signature: __________________________________________

 
If under 18 years, please state date of birth: ____/____/____

The following details are requested for our records and will help us to foster
the aims of the Society.

Occupation: __________________________________________
Interests: _______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

How did you hear about the society?

Member Newspaper Magazine
WASA Pamphlet Web Page
News letter Radio TV

Please give details as this is a great help in determining the effectiveness of our promotion
___________________________________________________________________________

Your reasons for joining: ______________________________________________________

Artists please complete the following:

Medium(s) used

Watercolour Oil Pastel
Mixed Media Ceramic Sculpture
Collage Acrylic Drawing

Other: ______________________________________________________________


Usual subjects

Birds Mammals Flora

Other ________________________________________________________

Date of birth if under 30 years: ____/____/____
Art school training:  ____________________________________________________


If you wish to, please attach a brief, A4 biography to add to our member's book.
*A non-exhibiting member has voting rights but is not eligible to exhibit or display art in any related Wasa publications or exhibitions.