Membership - Queensland

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Membership

Queensland

Membership & Renewal Application Form For Queensland
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

'Queensland Speak Easy Association'
Treasurer
PO Box 5342
WEST END QLD 4101

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
'Queensland Speak Easy Association' or 'QSEA'
and posted to
Treasurer
PO Box 5342
WEST END QLD 4101

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