Approved General Members – Payment Form Approved General Members - Payment Form Member DetailsFirst Name*Last Name*Contact Number*Email address* Organisation / company nameMembership Options*$150 - General Membership*if you would like to pay your membership fee via an alternate method, please contact the Variety office on 08 8293 8744Billing Address Street Address Address Line 2 City State Australian Capital TerritoryNorthern TerritoryNew South WalesQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Postcode I am happy to receive communication materials from Variety SA regarding upcoming news and eventsYesNoIf you have any questions, please don't hesitate to contact us on (08) 8293 8744 or [email protected]Pay your 2021 General Membership Fees - $150 GST inc.Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name CAPTCHA
