# Membership Application Form

BAROSSA FILM CLUB
January 2022 ABN 35 268 867 019
Name: _________________________ Receipt/Membership No. 2022 /________
Full membership is \$40 per person per calendar year and entitles you to bring a guest to two (2) screenings during the calendar year.
Limited membership is \$15 per person and entitles you to attend three (3) consecutive screenings during the calendar year.
You may join at any film session, or complete the portion below and return this form to:
The Treasurer, Barossa Film Club, PO Box 841, Tanunda, 5352.
Electronic funds transfer (EFT) payment / Cheques are to be made payable to:
Payee: Barossa Film Club BSB: 105 024 Account Number: 036217040
If you pay by EFT, kindly notify Ms Jill Lange by e-mail message to allan_jill@bigpond.com or SMS text to mobile 0427 002 610 advising your payment, together with your name and contact details so we may confirm receipt of your payment.
All film sessions are held in the Wine Education Centre, near the Brenton Langbein Theatre, Faith School, Magnolia Road, Tanunda commencing at 7:30 pm. Doors open at 7:00 pm.
Kindly contact Mr Allan Pearce by e-mail to allan_jill@bigpond.com or mobile 0417 002 708 to pre-book film screening attendances as numbers may be limited.
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Barossa Film Club | Membership Subscription Form | 2022
Name:
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Email:
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Postal
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Address:
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Phone:
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Amount:
\$40 / \$15 / Other \$. . . . . . . . .
Payment:
Cash / Cheque/ EFT / Other [specify] . . . . . .
Official Use Only Receipt/Membership No. 2022 /________