TAX INVOICE ABN 14 852 335 677 2019 MEMBERSHIP APPLICATION Please complete all sections clearly to ensure your access to the WIKI and resource updates. For Institutional please list all names and email addresses for those included in your membership for Wiki access. membership Please email this form to the NEW MEMBERSHIP SECRETARY Institutional Name (Institutional Membership only) Family Name Name(s): School/College/Workplace: Address: Postcode: Wk Mobile: Email: Please notify the Membership Secretary of any change of address. Indicate Membership Amount Payable Payment Type $ 60.00 Individual EFT ONLY Institutional $ 110.00 Account Name: LETASA BSB Number: 065 131 Pre Service Teacher $ 20.00 Acc Number: 1006 4914 Reference: International* (*required for all members $ 150.00 School Name (Institutional Membership) or with addresses outside of Member Name (Individual Membership) Australia) LETASA is a not for profit organisation and does not charge GST Send your Application form and Institutional Members Name: EFT notification to the Email: NEW Membership Name: Secretary Email: Agnes Medrecki Name: Email: Name: Email: Publication inquires to
TAX INVOICE ABN 14 852 335 677 2019 MEMBERSHIP APPLICATION Please complete all sections clearly to ensure your access to the WIKI and resource updates. For Institutional membership please list all names and email addresses for those included in your membership for Wiki access. Please email this form to the NEW MEMBERSHIP SECRETARY Institutional Name (Institutional Membership only) Family Name Name(s): School/College/Workplace: Address: Postcode: Wk Mobile: Email: Please notify the Membership Secretary of any change of address. Indicate Membership Type Amount Payable Payment Individual $ 60.00 EFT ONLY Account Name: LETASA BSB Number: 065 131 Acc Number: 1006 4914 Reference: School Name (Institutional Membership) or Member Name (Individual Membership) Institutional $ 110.00 Pre Service Teacher $ 20.00 International* (*required for all members with addresses outside of Australia) $ 150.00 LETASA is a not for profit organisation and does not charge GST Institutional Members Name: Email: Name: Email: Name: Email: Name: Email: Send your Application form and EFT notification to the NEW Membership Secretary Agnes Medrecki Publication inquires to