Membership and Donation

To join or donate to the Foundation please complete this form and submit for payment. Please note the Gallery is able to accept online payment by Visa and MasterCard. If you would like to make arrangements to pay by American Express or Diners Club cards please call (07) 3840 7287.
Title
Name/Company*
Contact (for corporate donations)
Address (line 1)*
Address (line 2)
City*
State*
Postcode*
Telephone (Private)*
Telephone (Business)
Facsimile
Email Address*

Acknowledgement (Please enter how you would like to be described in the Foundation Annual Report.)

Please select one of these three options:
 
1) I wish to join the Queensland Art Gallery Foundation as a:
  •  
 Individual $1,000-$4999
Corporate $5,000-$19,999
  •  
 Individual $5,000-$19,999
Corporate $20,000-$49,999
  •  
 Individual $20,000-$49,999
Corporate $50,000-$99,999
  •  
 Individual $50,000-$99,999
Corporate $100,000-$199,999
  •  
 Individual $100,000-$149,999
Corporate $200,000-$299,999
  •  
 Individual $150,000-$249,999
Corporate $300,000-$499,999
  •  
 Individual $250,000 or more
Corporate $500,000 or more
Pledge total - $AUD (Please note this amount can be paid as a lump sum or by annual instalments.)
OR
2) I am already a member and wish to further contribute to my membership by donating - $AUD (Please use this option for paying a membership instalment)
OR
3) I do not wish to join the Queensland Art Gallery Foundation but would like to make a tax deductible donation of -$AUD
My membership/donation will be made in the following manner.
Please select one of these two options:

1) One full payment in full of - $AUD (This amount will be debited to your credit card.)
OR
2) By instalments - annual payments of - $AUD
per year (The above amount will be debited to your credit card per year for the following amount of years.)

* Denotes compulsory information