Celtic
Studies Foundation
APPLICATION FOR MEMBERSHIP APPLICATION
/RENEWAL
Title:
Prof.
Dr
Mr
Ms
Mrs
Other
First name:
Surname:
Mailing address:
Telephone Number with area code:
Facsimile Number with area code:
Email:
I wish to
contribute to the Celtic Studies Foundation and
enclose a donation of (circle one):
$20
(pensioner/student)
$50
$100
$500
$1000
$2000
An annual donation of $50
gives voting rights as a FRIEND MEMBER;
an annual donation of $100 gives voting rights
and the right to stand for election to the
Council
as a DONOR MEMBER; GOVERNORS (annual donation of
$2000 or more) are automatically
members of the Council.
All donations to the University of Sydney are
allowable deductions under the provisions of
the
Income Assessment Act (Section
78(1)(a).
Please make
cheques/money order payable to "The
University of Sydney " and post to
Celtic
Studies Foundation H69
The University of Sydney
NSW 2006
Australia
If you wish to make your
payment through a Credit Card,
please fill in the details below and submit this
form.
Please debit my
Bankcard
Mastercard
Visa
Account
number:
Expiry
date:
Signature:
_________________________________________________________
In making this donation I
note that my membership of the Celtic Studies
Foundation
(which is an entity of the University of Sydney)
in whatever category is not dependent
on making this payment. I further note that I
expect to derive no personal benefit by
making this donation and I impose no restriction
on the Celtic Studies Foundation
concerning how the funds may be
applied.