AGTV INDIVIDUAL MEMBERSHIP APPLICATION /RENEWAL 2012

(includes membership of an AGTV Teacher Network)

About AGTV individual membership
Membership of a professional subject association can be used as evidence for VIT registration.

Membership supports the volunteer work of colleagues to provide services for teachers and students across Victoria.

Membership is for a calendar year, is tax deductible and entitles you to member rates for professional development
including AGTV Network Meetings, Primary and Secondary specific PD programs, and Victorian State Conference.

A subscription to SZENE, a national journal for teachers of German, is complimentary with each membership.

PLEASE PRINT CLEARLY

View the AGTV Privacy Policy on our Website: www.agtv.vic.edu.au

Name______

Mailing address ______

______Postcode ______Home Ph or Mob: ______

Please notify the AGTV of any change of your mailing address.

Contact E-mail ______

Workplace / Institution in 2011 ______

Have you changed workplaces in 2011? Yes / No

Please list the AGTV Network from which you receive AGTV e-newsletters:

AGTV Network: ______

Country Networks: Ballarat, Calder, Geelong, Gippsland, Hume, Wimmera

Metropolitan Networks: Inner Eastern, Knox Area Network, Monash-Whitehorse, North West, Outer Eastern, Southern

Invoice for 2012

*The AGTV is not registered for the GST & does not issue Tax Invoices

ABN: 69 688 318 657 - Inc.No. A0024716J

PO Box 498, Blackburn, 3130

Type of Victorian membership requested / Early Bird Rate Only
Received by 31st March
*GST not included / Yearly Rate
*GST not included
Individual Employed (tax deductible & evidence for VIT) / $60.00 /  / $65.00 / 
Individual Concession ( Not working / Retired ) / $40.00 / 
Undergraduate Student or Training Teacher of German or Assistant in School
Please provide a copy of student ID and state the course / school:
Course Name / Institution / School: / $30.00 / 
Method of Payment: Personal or School** Cheque  Cash  Online through PayPal 
**Please note that individual memberships paid by a school will only be accepted with a school membership
Membership will be current upon receipt of both payment and a completed individual application form.
NB: At the time of publication of SZENE, a copy is sent to all current members. Back copies may not be available.

Pay by cheque

Make cheque payable to AGTV and send (or email) this completed membership form to:

AGTV Membership, PO Box 498, Blackburn 3130

Please copy this invoice with cheque details for your records. Cheque #: ______

Payments online only – do not request if sending a cheque!

You do not have to have an account with PayPal to make payments. Credit cards: Visa/ Mastercard/ American Express.

E-mail this completed form to

Details of how to pay online through PayPal will be forwarded to your email address.

______

AGTV Use Only: Payment received  Entered on database 