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Membership & Renewal Application Form For New South Wales/ACT
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

'NSW/ACT Speak Easy Association'
Treasurer
PO Box 154
ST PAULS NSW 2031

If you prefer you can print the form and post it.
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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
'Speak Easy ' or 'ASEA'
and posted to
Treasurer
PO Box 154
ST PAULS NSW 2031
  DISCLAIMER