GTAQ Membership form

Geography Teachers’ Association of Queensland Inc.

ABN 94 808 029279

Application for Membership /Tax Invoice
Please complete this form and return with payment to

Geography Teachers’ Association of Queensland
c/- Royal Geographical Society of Queensland
237 Milton Road, Milton, QLD, 4064

Either - applying as a
NEW Individual Yes No ( Please circle )
or
RENEWING Individual Yes No ( Please circle )

Title: ........... Surname...........................................................

Given Name: ...................................................

School:................................................................................................................................


Or - applying as a
NEW School/Organisation Yes No ( Please circle )
or
Renewing School/Organisation Yes No ( Please circle )

Name of School/Organisation: .......................................................................................................

.............................................................................................................................................................

Contact Person: .......................................................................................

Position: .............................................................


Mailing Address: ......................................................................................................................................................................

Post Code ................ FAX ...........................................

Telephone: .........................................................(W) ................................................................(AH)

GTAQ is NOT registered for GST There is no GST claimable as part of this fee

2006 Membership fees

Individual $60
School or Organisation $130
Associate/Full Time Student $25

Method of Payment:

I enclose a cheque for $……………

OR

Please debit my credit card for $ ……… Bankcard Mastercard Visa ( Please circle )

Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Card Expiry Date: ……………

Name of Cardholder: ………………………………………………………

Signature: ……………………………………Date of Payment: …………

For help contact: Ph: 3368 2066 Fax: 3367 1011 Email: rgsq@gil.com.au
Office Use Only:
Receipt:……………………
Date: …………

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EMAIL : I give my approval for GTAQ to forward information to me by email and understand that such emails may from time to time contain information of a commercial nature such as notices of Conferences and professional development Activities.

E-Mail address

………………………………………….@………………………………………………………………

Signature ……………………………………………………………………………

If joining as a school, please photocopy one form for each teacher who is to receive emails from GTAQ and have them sign this section. Each form must be returned to GTAQ.