Membership Application Form

To be an effective national preservation organization,
OHTA needs your financial support as well as your advice,
interest and participation.

Please download and print this Membership Application Form and send to OHTA with your payment.




ORGAN HISTORICAL TRUST OF AUSTRALIA
ABN 99 005 443 372

MEMBERSHIP FORM

Cheques should be made payable to 'Organ Historical Trust of Australia'
Payment may also be made via Bankcard, Mastercard or Visa credit card accounts.

  • Ordinary membership
  • Overseas membership (airmail)
  • Family membership
  • Student* / pensioner membership
  • Life Membership
$50
$60
$62
$32
$1,000
* only available for full-time students under the age of 25

SPECIAL SUBSCRIPTION LEVELS

  • Benefactor
  • Sponsor
  • Corporate (for companies)
  • Sustaining Member


$500
$300
$250
$100




NAME_________________________________________________

ADDRESS______________________________________________

___________________________________STATE______________

POSTCODE__________ TELEPHONE_______________________

Email__________________________________________________


Payment: subscription $__________________________________

General donation (trust fund)* $____________________________

Donation (Ivor Matthews scholarship)* $_____________________

Hill & Son Restoration Appeal (SA)* $_______________________

Christopher Dearnley Award* $____________________________


TOTAL $_______________________________________________


* donations over $2.00 are tax-deductible and receipts will be issued



BANKCARD/VISA/MASTERCARD NO:
Please print clearly and check before sending


Signature_______________________________________________

Name on card ___________________________________________

Expires________/_______


Remittances, accompanied by this form, should be sent to:

Membership Secretary
Organ Historical Trust of Australia
Mr Andrew Davidson
GPO Box 676
SYDNEY NSW 2001
AUSTRALIA


or email to ohtamembership@yahoo.com.au