PLEASE SAVE AS PRIOR TO COMPLETING THIS FORM AND
SUBMIT BOTH PAGES TO firstname.lastname@example.org
Please tell us which of the following communication methods you find most useful:
Email Social Media Direct Mail SMS Phone Call
For your convenience, you will be automatically subscribed to communications related to your teaching levels and area of focus. You
may login to your account to adjust your subscription preferences at any time.
Membership Categories and Fees (includes GST)
Full Membership $ 140
Open to graduates from tertiary institutions and holders of relevant qualifications that are accepted by the Board.
Graduate Membership $ 90
Open to all 2020 tertiary institution graduates that meet the course specification of Full Membership.
Student Membership $ 50
Open to students currently enrolled in post-secondary institutions in any area that is acceptable by the Board. If
applying for student membership, please attach a copy of your student card.
Retired/Non-Working Membership $ 70
Open to persons who are retired/no longer working in the profession and wish to continue their support for ACHPER.
Amount Payable: $ ___________________________
Payment is available via credit card using one of our automated payment options.
Please select from one of the following payment options:
Monthly Automatic Renewal (Full: $12 per month, Graduate: $7.5 p.m., Retired: $6p.m., Student: $4.5p.m.)
Annual Automatic Renewal (Full membership fee renewable payment upon anniversary date each year)
Credit Card Type Visa Mastercard
Card Number _________ /_________ /_________ /_________ Expiry Date ______ /______ CVV ______
Cardholder Name _____________________________________ Signature __________________________________
Alternatively, check this box if your School would like to pay via EFT. An invoice with bank details will be sent to you.
NB: Membership does not become active until full payment has been received. Please allow one week for processing applications. Membership
fees are non-refundable. Automatic payments can be cancelled at any time online or via email to email@example.com. A tax invoice or receipt
will be issued by ACHPER SA and forwarded to your designated email address. Visit our website for Membership terms and conditions.