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The banner reads "Organisation Membership Application Form" in black text on a yellow background. Multiple images of artists performing their different arts practices are shown. Including someone dancing in a blue dress, someone standing next to a colourful, outdoor mural, someone patching a synthesizer and a singer with an acoustic guitar.

Regional Arts Victoria - Organisation Membership

Data Collection Notice:

Regional Arts Victoria collects this information in order to service members in the Membership and Insurance Program.

We may share this information with GSA Insurance Brokers.

If you have any questions about your personal information will be handled or would like to gain access to your personal information, you can contact Regional Arts Victoria on 1300 882 531 or membership@rav.net.au.

Application Step 1 - Complete this form and make payment

► Allow up to 10 business days for your membership application to be processed

► Look for a welcome email and receipt in your inbox

Application Step 2 - Complete the GSA insurance form

► Please complete if you choose to opt into any of RAV's insurance policies

► Insurance applications can take 1-2 weeks to be approved

► For new members, insurance certificates valid to 31 October 2026 will be emailed to you

► Insurance certificates valid to 31 October 2027 will be sent by email in late October 2026

RAV Insurance Available	Association Liability	Volunteer Workers	Combined Liability Insurance
NFP Small Creative Organisation	✓	✓	✓
For Profit Small Creative Organisation	✕	✓	✓

Membership Terms and Conditions

I have read and understood the Membership Terms and Conditions.

Eligibility

Organisation Name
Contact us if your name has changed.

Organisation Name

Is your organisation's principal place of business in the State of Victoria?

YesNo

Does your organisation have the promotion of regional arts or cultural pursuits as a primary or principal focus?
(e.g. Your organisation runs regional events or works with regional artists)

YesNo

Is your organisation incorporated in the State of Victoria, Australia?

YesNo

Is your organisation a registered not-for-profit or charitable organisation?

YesNo

What was your gross income for the last year, including grants (include the last financial year that your organisation has completed a tax return). If your organisation is new and you have no current funding please enter 0.

Numbers Only! 10000 not $10,000

evaluate insurance offering

Ineligible

Based on your responses above, we are sorry to say you are not eligible for Organisation Membership. If you would like to stay in touch with Regional Arts Victoria please sign up for our enews here

Ineligible for master Combined Liability Insurance policy

Based on your response that your organisation has a gross annual income over $1,000,000, you are eligible for Organisation Membership. However, you do not qualify for our master Combined Liability insurance policy. Please continue the form if you would like to continue your membership application. Contact us if you have any questions.

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Organisation Information

Organisation Phone Number

For general enquiries

Organisation Email

For general enquiries

Membership communications will only be sent to the nominated Primary Contact

Organisation Website

Postal Address

Traditional Place name (if usure please leave blank)

Further information: https://aiatsis.gov.au/explore/map-indigenous-australia

Mailing Street Address

Mailing Suburb

Mailing State

Mailing Postcode

Is your street address different from the above?

Street Address Information

Traditional Place name (if usure please leave blank)

Further information: https://aiatsis.gov.au/explore/map-indigenous-australia

Street

Suburb

State

Postcode

Government

Which Local Government Council or Shire is the organisation based in?
If unsure click here.

Which State Government Electorate is the organisation based in?
If unsure click here.

Which Federal Government Electorate is the organisation based in?
If unsure click here.

Membership Contacts

President or Director

First Name

Last Name

Mobile Phone

Other Phone

Email

Secretary or Administrative Contact

First Name

Last Name

Mobile Phone

Other Phone

Email

Treasurer or Finance Contact

First Name

Last Name

Mobile Phone

Other Phone

Email

Primary Contact

The primary contact will receive all renewal information, insurance information and all other notifications from Regional Arts Victoria by email.

Nominated Voter

The Nominated Voter will receive all information about Board nominations, voting processes, Annual General Meetings and Special General Meetings by email.

Declaration

I confirm that the information I have provided in this form is true and correct, and that I am authorised to submit this information on behalf of my organisation.

Full Name

Position

Date

Promotion Code

If you opted into insurance cover

Please complete the insurance application form on the GSA website to finlise your insurance application. You will be directed there after this form.

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Circus	Community Arts
Craft	Cultural Development
Dance	Digital Media
Festival	Film
Jewellery	Literature
Multi-art form	Music
Performing Arts	Photography
Sculpture	Textiles
Theatre	Visual Arts
Writing	Other

Page 2

NFP Organisation Membership with Combined Liability Insurance

Included in your Membership:

Fees:

$2,370 (GAI $100,001 to $200,000)
$4,146 (GAI $200,001 to $500,000)
$4,326 (GAI $500,001 to $1M)

For Profit Organisation Membership with Combined Liability Insurance

Included in your Membership:

Fees:

$2,370 (GAI $100,001 to $200,000)
$4,146 (GAI $200,001 to $500,000)
$4,326 (GAI $500,001 to $1M)

For Profit Organisation Membership with Combined Liability Insurance

Included in your Membership:

Fees:

$284 (GAI Up to $5,000)
$453 (GAI $5,001 to $10,000)
$680 (GAI $10,001 to $20,000)
$1,020 (GAI $20,001 to $50,000)
$1,421 (GAI $50,001 to $100,000)

NFP Organisation Membership with Combined Liability Insurance

Included in your Membership:

Fees:

$284 (GAI Up to $5,000)
$453 (GAI $5,001 to $10,000)
$680 (GAI $10,001 to $20,000)
$1,020 (GAI $20,001 to $50,000)
$1,421 (GAI $50,001 to $100,000)

For Profit Organisation Membership

Included in your Membership:

For Profit Organisation Membership

Included in your Membership:

For Profit Organisation Membership

Included in your Membership:

NFP Organisation Membership

Included in your Membership:

NFP Organisation Membership

Included in your Membership:

NFP Organisation Membership

Included in your Membership:

Postal Address

Page 2

NFP Organisation Membership with Combined Liability Insurance

Included in your Membership:

Fees:

$2,370 (GAI $100,001 to $200,000)$4,146 (GAI $200,001 to $500,000)$4,326 (GAI $500,001 to $1M)

For Profit Organisation Membership with Combined Liability Insurance

Included in your Membership:

Fees:

$2,370 (GAI $100,001 to $200,000)$4,146 (GAI $200,001 to $500,000)$4,326 (GAI $500,001 to $1M)

For Profit Organisation Membership with Combined Liability Insurance

Included in your Membership:

Fees:

$284 (GAI Up to $5,000)$453 (GAI $5,001 to $10,000)$680 (GAI $10,001 to $20,000)$1,020 (GAI $20,001 to $50,000)$1,421 (GAI $50,001 to $100,000)

NFP Organisation Membership with Combined Liability Insurance

Included in your Membership:

Fees:

$284 (GAI Up to $5,000)$453 (GAI $5,001 to $10,000)$680 (GAI $10,001 to $20,000)$1,020 (GAI $20,001 to $50,000)$1,421 (GAI $50,001 to $100,000)

For Profit Organisation Membership

Included in your Membership:

For Profit Organisation Membership

Included in your Membership:

For Profit Organisation Membership

Included in your Membership:

NFP Organisation Membership

Included in your Membership:

NFP Organisation Membership

Included in your Membership:

NFP Organisation Membership

Included in your Membership:

Postal Address

$2,370 (GAI $100,001 to $200,000)
$4,146 (GAI $200,001 to $500,000)
$4,326 (GAI $500,001 to $1M)

$2,370 (GAI $100,001 to $200,000)
$4,146 (GAI $200,001 to $500,000)
$4,326 (GAI $500,001 to $1M)

$284 (GAI Up to $5,000)
$453 (GAI $5,001 to $10,000)
$680 (GAI $10,001 to $20,000)
$1,020 (GAI $20,001 to $50,000)
$1,421 (GAI $50,001 to $100,000)

$284 (GAI Up to $5,000)
$453 (GAI $5,001 to $10,000)
$680 (GAI $10,001 to $20,000)
$1,020 (GAI $20,001 to $50,000)
$1,421 (GAI $50,001 to $100,000)