Kulcha - Multicultural Arts of Western Australia

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KULCHA
Multicultural Arts
WA Inc
1st Floor
13 South Terrace
(above the Dome Café)
Phone: (08) 9336 4544
Fax: (08) 9336 4463

email mawa@kulcha.com.au

ArtsWA

Australia Council

Lotteries Commission

BankWest

Healthway and Heart Foundation

Dome Fremantle



 Multicultural
Arts of
Western
Australia
Kulcha membership form

Title
Family Name
Given Names
Organisation
For family or group membership, please provide a name for the second card.
Second name
Address
Town/
Suburb 		Postcode
Email
Phone (H) Phone (W)
FAX
Cultural
Heritage
Profession/
Occupation
Interests
Dance Drama Music
Visual Arts Literature
Other :
Membership New Renewal
class of membership
Individual Member $40 inc GST
Group / Family Member $50 inc GST
Association / Organisation $70 inc GST
Corporate Member $125 inc GST
Individual Life Member $250 inc GST
Corporate Life Member $1250 inc GST

I would also like to add a donation
$
all donations over $2 are tax deductable

I would like to support Kulcha
In kind sponsorship volunteer work
choose payment option (1,2 or 3)
1 Email credit card details
  • Fill in Credit card details
Card Type
Visa Mastercard Bankcard
Amount $
Card Number
Expiry Date /
Name on Card

Signed
______________________________________
(if by fax or post)
  • Submit your application form here

2 Credit card details by fax or post

  • Print this form on your computer printer
  • Submit your application form here and now
  • Write your credit card details
    onto your printed form
  • Fax it to Kulcha (08) 9336 4544
    OR
    Post it to Kulcha
    PO Box 1555
    Fremantle WA 6959

3 Payment by cheque

  • Print this form on your computer printer
  • Submit your application form here and now
  • Write your cheque
    and attach it to the printed form
  • Post it to Kulcha
    PO Box 1555
    Fremantle WA 6959
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