Associate Membership Enrolment Form Your Details Please fill in your details below. All fields are required: Your name Your email Your address Your phone Your date of birth Associate Membership Information Annual Associate Membership fees: - Single ($10). - Family ($15) 1-2 parents and up to 3 children under 18. Memberships and class to be approved by ECH Committee of Management per Association Rules. Please note that any course enrolment fees are in addition to membership fees. NOTE: This form is intended for an Associate Membership (and any associated course enrolments). Contact ECH to inquire with regards to Full Membership eligibility and requirements. Payment information and instructions are outlined towards the bottom of this form. Enrolment Details This section contains information related to enrolment. If you are not enroling in any sessions, you do not need to fill in this section. Please provide details of any courses you wish to enrol (If any): Course #1 (leave blank if not required) Course Name Course Date/Time Course Fee Course #2 (leave blank if not required) Course Name Course Date/Time Course Fee Course #3 (leave blank if not required) Course Name Course Date/Time Course Fee Payment Options A reminder for payments that fees will need to include the annual membership fee along with all course fees owing. There are a number of ways to pay. Please nominate your method of payment (required): Cash: In person at 356-358 Beligrave-Gembrook Road, Emerald 3782, M,W,F, 10am-3pm.Direct Debit: BSB 063 842 Acct 1009 3095, Identify course name, membership type in bank description field.Credit/Debit Card - Prepay: Please contact ECH directly to arrange processing M,W,F, 10am-3pm.Credit/Debit Card - Pay on the day: Choose if paying by card, but will pay on the first day of your course. Our Details Emerald Community House is located at: Street Address: 356-358 Belgrave-Gembrook Road, Emerald Victoria 3782 Postal Address: PO Box 328, Emerald 3782 Phone: 03 5968 3881 Email: emhouse@iinet.net.au Web: https://www.echvic.org.au Acceptance and Agreements ECH Association Rules are available on the ECH Website: https://www.echvic.org.au/about-us In order to process this application, you must understand and tick both check boxes below: By checking this, I agree to abide by the Association Rules and terms of this application. By checking this, I agree that it serves as a valid substitute for a wet signature.
