Membership Application

*: mandatory items

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Title:	*
First name in English:	*
Last name in English:	*
Full name in Chinese (if applicable):
Mailing Address Line 1:	*
Mailing Address Line 2:
Post Code:	*
Primary Phone/Mobile Number:	*
Secondary Phone/Mobile Number:
Email:	*
	I am currently a teacher. I am currently studying. *
School at which you work:
VIT (Victorian Institute of Teaching) Number:
Year Levels Taught:
Institution at which you study or have studied:
Would you like to provide some PD sections for CLTAV?	Yes No
If YES, please give a brief description of the program you would like to provide:
Fee payment methods (please select one of the following methods to pay your fee)	Bring the cash to pay when you come for next general meeting. Send the cheque to the following address (cheque made payable to: CLTAV Inc): Ms Min Lu, PO Box 1037 Bundoora VIC 3083 *

Alternatively, you can download the form here and email to the secretary: secretary@cltav.org.au