QAGOMA Membership

Please note the Gallery is able to accept online payment by Visa and MasterCard only. If you would like to make arrangements to pay by American Express or Diners Club cards please call +61 (0)7 3840 7278.

MEMBERSHIP TYPE

Type of Membership *
Membership Categories *
Individual Membership Prices *
Dual Membership Price *
Family Membership *
Premium Membership
Welcome pack to be sent to *
Renewal to be sent to *
Concession number

Your Details

Title *
First name *
Surname *
DOB *
Address *
Suburb *
State *
Country *
Postcode *
Telephone (home) *
Telephone (work)
Mobile
Email *

Gift Recipient Details

Title *
First name *
Surname *
DOB *
Address *
Suburb *
State *
Country *
Postcode *
Telephone (home) *
Telephone (work)
Mobile
Email *
Personalised Gift Message *

Second Card Holder

Title of partner/spouse *
First name *
Surname *
DOB *

Child Card Holder/s

Full name *
DOB *
Full name *
DOB *
Full name *
DOB *

About Me

Age

Which programs & events are of particular interest to you?

Please specify *

Which of these titles best describes you?

Please specify *
Please specify *

Please tell us how you heard about this program:

Please specify *

Would you like to sign up for membermail email alerts?

Please note, ten business day are required to process your membership. All information provided on this form will remain strictly confidential and for use by QAGOMA only. For further information please refer to the Privacy & Security Statement on the QAGOMA website.

* Denotes compulsory information
1 Name of partner/spouse for Dual and Family memberships only
2 Children's names and dates of birth for Family memberships only. Family memberships are for two adults and their children under 18 years living at the same address.
** Concessions are offered to holders of Government-issued cards for pensioners, the unemployed and full-time students only. Full-time student ID card must be shown. Seniors Business Discount Cards do not qualify for a concession.
** Regional membership is offered to people who live more than 80 kilometres from Brisbane.