AF de CQ - 2021 Membership Application or Renewal Form

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Please complete this form only if you are not a student.

Please note:

● your application will be confirmed at the next Committee Meeting of the Alliance Française de Central Queensland;
● the membership year starts 1st January and ends on 31st December of each calendar year;
● family memberships are entitled to member’s rates for up to two adults and two children;
● activities of the AF de CQ are covered by the Public Liabilities Insurance.

Firstname *

Surname *

Address (in full, including postcode please) *

Telephone or Mobile *

Email (we will send you occasional communication) *

Membership Type *

Single - $25

Family - $40

Names of other family members (if applying for Family Membership)

Please pay your membership fee either:

a) By electronic transfer to our account: Alliance Française de Central Queensland;
BSB: 064709; Account No: 10257936. Please use your surname as reference.
b) By a cheque payable to “Alliance Française de Central Queensland” posted to us.
c) By cash, handed over to the Treasurer or a Teacher.

Declaration *

I would like to become a Member of Alliance Francaise de Central Queensland.

Required

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