Fillable Membership Application Form Contact Information Year of birth (Australian National University)

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Membership Application Form Contact Information Year of birth (Australian National University)

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The Membership Application Form Contact Information Year of birth (Australian National University) form is 2 pages long and contains:

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  • 35 check-boxes
  • 31 other fields

Country of origin: AUSTRALIA
File type: PDF

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Australian Council for Health, Physical Education and Recreation, South Australian Branch
132 Rose Tce, Wayville, SA 5034| ABN 56 064 377 067 | PH 08 8363 5700 | WEB www.achpersa.com.au | EMAIL info@achpersa.com.au
Membership
Application Form
PLEASE SAVE AS PRIOR TO COMPLETING THIS FORM AND
SUBMIT BOTH PAGES TO info@achpersa.com.au
Contact Information
Title First Name Surname
Year of birth Email address
Home Phone Mobile Phone Business Phone
Employment/Study
Year of Graduation Place of Study
Place of Employment
Job Title
Postal Address – Personal or School? __________________
Street/PO Box
Suburb State Postcode
Billing Address (if different from above) – Personal or School? ___________________
Street/PO Box
Suburb State Postcode
Role (tick all that apply)
Principal Classroom Teacher Specialist Teacher
Leadership/Coordinator Education Officer Lecturer
Student Sport Coach Other_________________________
Teaching Level/s (tick all that apply)
Primary (F-6) Secondary (7-10) Senior Years (11-12)
Tertiary Other ______________
Area of Focus (tick all that apply)
Physical Education Health Education Outdoor Education
Sport Education Sport Coaching Health Promotion
Community Fitness Recreation/Physical Activity Exercise/Sport Science
School
Same as above
Australian Council for Health, Physical Education and Recreation, South Australian Branch
132 Rose Tce, Wayville, SA 5034| ABN 56 064 377 067 | PH 08 8363 5700 | WEB www.achpersa.com.au | EMAIL info@achpersa.com.au
Membership
Application Form
PLEASE SAVE AS PRIOR TO COMPLETING THIS FORM AND
SUBMIT BOTH PAGES TO info@achpersa.com.au
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.
Payment Details
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 info@achpersa.com.au. 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.
Please return completed form to:
ACHPER SA - 132 Rose Tce, Wayville, South Australia 5034
or email to info@achpersa.com.au
For any queries please contact ACHPER SA on (08) 8363 5700 or info@achpersa.com.au
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Membership Application Form Contact Information Year of birth (Australian National University)

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Completed 23 March 2021

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