Before you begin you will be required to enter your first name, last name and email address to be allocated to your membership. This email address can only be used once to create a membership.
This form will take all the information that you enter and select the membership that best suits your requirments. At the end of the application you will be presented with the final value of your membership where you can then accept or decline.
| First Name: | |
| Last Name: | |
| Email: |
| Your address | |
| Town/Suburb: | |
| State: | |
| Contact details | |
| Phone Number: | |
Please list ALL family members included in the Membership. The first member has been done for you:
Include each person's first and last names. Separate individuals by starting a new line (hit enter on your keyboard).
Children under the age of 18 are free.
Children under the age of 13 must be accompanied by an adult (18 and over) when attending any Arts Yackandandah or Community Choir event
Who of the following individuals are under the age of 18?
Tick the box only if they are under 18 (does not include individuals who have already turned 18)
Who of the following individuals are included in the Community Choir Membership?
Here is a summary of your membership. Please check that all is correct before proceeding.
| Arts Yack: | ||
| Community Choir: | ||
| Total: |
| Email: | |
| Phone Number: | |
| Town/Suburb: |
Before proceeding with your application you must first agree to our terms and conditions.
| Name on Card: | |
| Card Number: | |
| Expiry Date: | |
| CVV: |