Membership - All Other States

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Membership

All Other States

Membership & Renewal Application Form For All Other States
Our membership period is from 1st January to 31st December each year

To join Speak Easy please complete the form and press submit and post your cheque to

'Australian Speak Easy Association'
National Treasurer
PO Box 114
MOUNT OMMANEY QLD 4074

If you prefer you can print the form and post it to us
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To make a donation to our Association go to our donation form

Required fields *

Please accept my application for membership to Australian Speak Easy Association

*Type of membership
(Tick one box)

Ordinary

Family

Associate

*Concessional

*Junior

*Joining Month

January, February or March

$35.00

* $20.00

Tick one box

April, May or June

$27.00

* $15.00

July, August or September

$18.00

* $10.00

October, November or December

$9.00

* $5.00

(* concession card holder/full time student or junior under 17 years)

Personal details

my details are available for the use of ASEA only; or

my details are also available to related speech & research organisations

*Age group
(Tick one box)

under 10

10-19

20-29

30-39

40-49

50+

Title:
*Full Name:
*Postal Address:
*Suburb/Town:
*State:
*Post Code:
*Home Phone Number:
Email:

I have posted a cheque for including/or a donation of * on (Date)

("The ASEA is a registered Public Benevolant Institution (DGR 486 946)")
("Donations over $2 are tax deductible")

Would you like a receipt
Yes No

Cheques should be made payable to
'Australian Speak Easy Association' or 'ASEA'
and posted to
National Treasurer
PO Box 114
MOUNT OMMANEY QLD 4074

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