Membership Renewal Form 1 July 2024–30 June 2025
Name
*
First Name
Last Name
Contact Details
Postal Address
*
Street Address
Street Address Line 2
City
State / Territory
Postal Code
Email
example@example.com
Mobile Number
Please enter a valid mobile phone number.
Phone Number
Please enter a valid landline phone number (only of no mobile number).
Participation
I am a:
Dancer
Adjudicator
Examiner
Musician
Teacher
Tutor
My qualifications are:
Full R.S.C.D.S. Certification /R.S.C.D.S. Units 2–5
Part R.S.C.D.S. Certification /R.S.C.D.S. Units 2–3
Non-R.S.C.D.S. Certified
Rules
I wish to renew my membership of the Royal Scottish Country Dance Society Queensland Branch Inc ("the Branch").
*
Yes
I agree to be bound by the rules of the Society and Constitution of the Branch (including future amendments which may be issued from time to time) for the term of my membership.
*
Yes
I understand the Branch does not carry any personal injury insurance, and I will be responsible for organising such cover should I deem it necessary.
*
Yes
Membership Fees
Membership Type
Single $67
Joint $116 (each)
Joint (second member)
Young Adult (18–25 years) $53.60
Youth (12–17 years) $33.50
Associate (full membership in another branch) $21.10
Joint Member
First Name
Last Name
Date of Birth
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a year
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
Year
Home Branch
Branch Newsletter
Digital
Print $10
Headquarters Magazine
None
Digital
Print (note: Print magazine distribution is a major component of the HQ membership price)
Headquarters e-Newsletter
Yes
Authorisation
I authorise the Branch to provide my details to the Royal Scottish Country Dance Society in order to register my membership with the society headquarters.
*
Yes
Payment
Amount Due
Payment Method
*
Electronic Funds Transfer
Cash
Cheque
EFT BSB
EFT Account
EFT Reference
Sign & Submit
Signature
Continue
Continue
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