Ceramic Arts Queensland Membership Subscription

Please enter information on the form below to process application for Ceramic Arts Queensland Membership.

Username*

Password*

Retype Password *

First Name *

Last Name *

Organisation

A.B.N.

GST Status

Not Registered

Registered

Address *

Address2

City *

Post Code *

Country *

State *

Phone

Email *

Membership Type *

Full Member ($35)

Group Membership ($60) Includes Printed Bulletin

Full-time Student/Concession Card Holder ($20)

Supporter ($20)

Printed Bulletin *

Yes ($30)

Donation

Price

Payment Method

Square

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

I accept Terms and Condtions

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