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

ANZ gateway THIS ONLINE FORM ACCEPTS CREDIT CARD PAYMENTS ONLY.

You will be directed to the ANZ eGate secure payment facility after you have submitted your form.
If your payment is successful, your transaction receipt number will appear below.
You will also receive a confirmation email, which includes a copy of your receipt number and the information you have provided on the form.

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

Group Insurance Additional Members 2023/2024

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)

Group Membership Number

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: 128 MB.

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

Number of New Group Members (Required)

Price: $ 7.50

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

Total

Comment