Membership Application

*Name:
Address:
Suburb:
Post Code:
Home Phone:
Work Phone:
Mobile Phone:
Email:
Occupation:
Birthday:
Instrument(s), other performing interests and any relevant qualifications (OHS, Fire-warden, etc)
Order BSB Polo Shirt ($30 each)
Order BSB Formal Shirt ($35 each)
Fees Paid
1. I hereby apply for membership of the Brisbane Symphonic Band Inc for the year 2012 2. I agree to abide by the membership conditions as set out in the constitution and rules as summarised in the Membership Information Pack 3. I acknowledge that, as a result of me becoming a member of the Band, my image and/or my performance, captured in the form of photographs or audio or video footage, taken or recorded at performances or other events, may be used for Brisbane Symphonic Band promotional or archival purposes 4. My personal details will be published on a list for Band members’ use only 5. I undertake to pay my annual subscription fee of $160 or $80 if you are a full time student by 1 March or within 4 weeks of first attendance [Note: Fees may be paid on a half-yearly basis. Late payments will incur a $10 late fee. Full time students will need to provide their student ID.]
I agree

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