MEMBERSHIP

FORM
OUR MISSION

Creative Gladstone
97 Auckland Street
P O Box 576
Gladstone QLD 4680
memberships.cgri @gmail.com
creativegladstone.org.au

Creative Gladstone's mission is to bring together, visual artists and crafts people with the purpose of forming a vibrant art
community within the Gladstone Region, provide artists and those interested in the arts with a centre in which to conduct
activities to socialise, learn, network, build professional arts practices, develop skills, promote and sell their work.

NEW MEMBER

RETURNING MEMBER (If you are a returning member please only add details which may
have changed since you filled out your last membership form.)

First Name:

CONTACT DETAILS
Last Name:

Street Address:

Town/City:

Postal Address:(if different)

State:

Phone (home):

Phone (work):

Mobile:

Post Code:

Email:

AREAS OF INTEREST (Please select the areas of the arts that you are interested in)
Beading
Paper Art and Bookbinding
Sculpting
Drawing
Paper Tole
Silver Smithing
Embroidery
Photography
Smocking
Henna and Body Art
Poetry
Spinning/Weaving/Knitting/Crocheting
Mosaic
Pottery
Textile Art
Felting
Print Making
Writing
Painting - Oils or Acrylics
Quilting
Other(s) (please specify)
Painting - Watercolour
Recycle Art
Painting - Pastel
Scrapbooking
MEMBERSHIP OF THE ART CENTRE - YOUR INVOLVEMENT IN CREATIVE GLADSTONE (please tick appropriate boxes)
Art Centre Volunteer (please indicate your level of participation as a Volunteer)
As a Volunteer I would be available:
Weekly
Fortnightly
As a Volunteer my preferred day(s) would be:
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Exhibitor
Supplier (provide your art work for sale at the Centre, Galleries or Art Spaces)
Teacher (Specify the areas of art you specialise in)
Workshop Participant
Committee Member
Other (Please specify)
Are you currently a member of an art group (s), e.g. Mount Larcom Art Gallery and Museum, Gladstone Regional Art
Gallery and Museum? (please specify)

MEMBERSHIP FEES (1 JULY 2014 - 30 JUNE 2015)

N.B. PRO-RATA FEES APPLY - (CIRCLE APPROPRIATE MEMBERSHIP FEE)

Volunteer

Family

General

Concession

Under 18

(non-artist)

(2 Adults, 2 Children)

July, Aug, Sep

$50.00

$40.00

$20.00

$10.00

$80.00

Oct, Nov, Dec

$37.50

$30.00

$15.00

$7.50

$60.00

Jan, Feb, Mar

$25.00

$20.00

$10.00

$5.00

$40.00

Apr, May, Jun

$12.50

$10.00

$5.00

$2.50

$20.00

PTO Continued Overleaf

If you have chosen Family Membership please list other names and ages. (Up to 3 additional members)
Name

Age

Email Address (if different from main applicant)

YOUR METHOD OF PAYMENT (TICK APPROPRIATE BOX)

Cheque
Direct Deposit/Bank Transfer
Cash

A/CCreative
Name: Creative
Gladstone
Region Inc.
Gladstone
Region Inc.
BSB:
124-073 (Bank of Queensland)
BSB:
124-073 Bank of Queensland
A/C No:
21711514
A/C No:(Your 21711514
Reference:
name)

For postal membership payment, please attach your cheque or a copy of the direct deposit / bank transfer confirmation.
If paying cash, please come into the centre and our volunteer will be happy to help.
Centre Hours Mon-Fri 10am-4pm Sat 9am to 1pm. Call on 07 4903 1952.
Note: All monies are deposited in a Bank of Queensland Account, accounted for and as an Incorporated Association (audited annually and financial
reports presented to the Members at the Annual General Meeting).

Please forward your completed Member Application form to: Membership Coordinator
Creative Gladstone
P O Box 576
Gladstone QLD 4680
DECLARATION
I understand that the information I provide in this document will remain confidential, my personal details will be
maintained in the Creative Gladstone membership database and that statistical information will be used, without
reference to my personal details, to further the formation of an Arts Centre within the Gladstone Region, and to
substantiate funding submissions.

Signed

1.
2.
3.
4.
5.

Dated

MEMBER BENEFITS
Participate in discounted workshops.
Hire workshop space at discounted rates.
Use of the Creative Gladstone Art Centre facilities and equipment to develop and share your skills.(e.g hire of printing
space after induction).
Opportunities to submit expressions of interest for displays such as the Gladstone Regional Library.
Opportunities to submit expressions of interest to conduct commercial art services for corporate partners and
projects.
Note:
All items displayed in the retail shop, at market and promotional stalls and in gallery spaces operated by Creative Gladstone are at the risk of
the owner, these items are not covered by Creative Gladstone Insurance.
All tutors must present Creative Gladstone with a copy of their own current Public Liability Indemnity insurance at the time of booking
workshop space.

Thank you, your contribution to the Creative Gladstone Art Centre is greatly appreciated and we look forward to
working with you.
FOR OFFICE USE ONLY
Date Data Entered (Please initial)
Presented to Committee (Initial)
Membership fee received circle either
Cash/Cheque/Direct deposit
Receipt no:______________________
Signed off by:
Name:

Position on committee: