Workshop Application Step 1 of 3 33% PhoneThis field is for validation purposes and should be left unchanged.Please complete this form to attend a workshop.Are you a member? Yes No Membership NumberName(Required) First Last PhoneEmail(Required) Enter Email Confirm Email Emergency Contact(Required) First Last Emergency Contact Number Workshop NameDate DD slash MM slash YYYY Tutor NameWorkshop FeeAmount Paying NowDeposit or Full Payment? Deposit (50%) Full Payment Payment Method Cash – in person collection Direct deposit • Minimum of 6 participants required for workshop to proceed. • Advertised prices apply to current financial members. • Non-members pay an additional $10 fee. • Non-members are not covered by Club insurance. • Full payment must be received 2 weeks prior to workshop date. • Places are confirmed once payment and application are received. • Refund requests may be considered by the executive committee.Agreement and Declaration(Required) I have read, understand, and agree to the Workshop Policy Statement. I confirm the information provided is correct and I wish to apply for this workshop. Direct Deposit Details BSB: 633 000 Account Number: 134 079 656 Account Name: Alice Springs Quilting Club Reference: Surname / Membership Number & Workshop Name
