Group Insurance Additional Members Form

QuiltNSW: The Quilters' Guild of NSW / Forms / Group Insurance Additional Members Form

THIS ONLINE FORM ACCEPTS CREDIT CARD PAYMENTS ONLY.

On successful submission of the form you will receive 2 emails. A confirmation email, which includes a copy of the information you have provided on the form. A second email will provide your payment receipt. If you do not receive both emails please contact membership@quiltnsw.com

QuiltNSW does not collect nor store any credit card information in conjunction with this payment facility.

This form is for Member Groups that already hold Public Liability Insurance through QuiltNSW who wish to add new members to their cover.

For any further information, please e-mail: membership@quiltnsw.com

Group Name(Required)

Name of Contact Person(Required)

First Name Family Name

Postal Address(Required)

Street Address City State Post code

Preferred phone contact(Required)

Email(Required)

Group Membership List(Required)

Drop files here or

Max. file size: 512 MB.

Please upload your list of names of your members in alphabetical order by Family Name.

Number of New Group Members (Required)

Price: $ 9.00

Enter the total number of new members you are adding to your group

Additional Members Fee

Credit Card(Required)

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