Regional Arts Victoria Individual Membership Application

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With this form, you have the option of renewing or applying for:

  • Both Membership and Public Liability Insurance*
  • Membership only
All applications and renewals take a minimum of 10 business days to process.

Questions about Insurance?

Please read the Individual Membership Information PDF on our website, request policy documents from and then contact Anne Buckley at Arthur J Gallagher Insurance on (07) 3367 5243 or at
If you require assistance with the online form please contact the Regional Arts Victoria Membership team at or by phone on 1300 882 531. 

Contact Information
If your name has recently changed, please let us know prior to completing this form

For general enquiries

Further information:

Physical Address 

Further information:

If you are not based in Victoria, please select NOT IN VICTORIA from each list

Your Arts Practice

Please briefly describe your artistic practice

You will be subscribed to Enews automatically if you do not tick this box

Page 3 - Insurance details

Individual Members can access the following insurances:
  • Combined Products & Public Liability and Professional Indemnity Insurance (at cost)

Combined Liability Insurance
Regional Arts Victoria offers Members the option to purchase Combined Liability Insurance. The following responses will assist the insurance broker to assess your eligibility.

If you have concerns regarding your eligibility for Combined Liability Insurance, please contact:
Anne Buckley at Arthur J Gallagher Insurance on (07) 3367 5243 or at

Business Address

Business Street Address

Please estimate the following annual figures for any public performances, exhibitions, workshops or classes (please enter '0' for not applicable)

Please estimate the number of attendees or patrons:

Who works with you?


Professional Indemnity Insurance

Public Liability Insurance
This policy does not cover liability in respect of Contractual liability: Any obligation assumed by You under any agreement or contract except to the extent that:

(a) the liability would have been implied by law;
(b) the liability arises from a provision in a contract for lease or real or personal property other than a provision which obliges You to effect insurance or provide indemnity in respect of the subject matter of that contract;
(c) the liability is assumed by You under a warranty of fitness or quality as regards to Your Products;
(d) the obligation is assumed under those agreement specified in the Schedule

Page 4 - Equity & Diversity

Regional Arts Victoria is committed to ensuring everyone can access the arts. Capturing data on the diversity of our members is one of the ways we can measure our progress and set goals for continual improvement. The below section is entirely optional, but will assist us in evaluating how inclusive our program is over time. 

If you do not wish to provide diversity data, please click Next Page.

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Membership Registration Summary

Promotion Code

Total Amount & Payment

You will be presented with the total amount to pay based on your submission and proceed to PayPal. 
A minimum of 10 business days is required to process all applications.

Please use the Previous Page button to review your form carefully prior to finalising.
When ready, click the Submit button below