Approved General Members – Payment Form Approved General Members - Payment Form Member DetailsFirst Name* Last Name* Contact Number* Email address* Organisation / company name Membership 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 events Yes No If 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 ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name CAPTCHA Δ
