Membership Form

CONTACT INFORMATION

Name *
Name of School / Institution *
Address
City
State
ZIP code
Country
Email Address *
Best Contact Number *

TEACHER(S) ASSOCIATED WITH MEMBERSHIP

(Please provide the details of each teacher below)

Teacher 1
Email Address
Type of Memberhship
Main Area of Interest
Teacher 2
Email Address
Type of Memberhship
Main Area of Interest

PRIVACY STATEMENT

I consent to the collection, storage, use and disclosure of my personal information in accordance with the History Teachers' Association of WA privacy policy which contains information about how I may access and seek correction of my personal information, how I can complain about a breach of my privacy, and how the complaint will be dealt with.


PAYMENT DETAILS

Please select the membership best suited to your needs (Refer here for description of categories)
NB: Student Membership requires a student email address

Membership Type
Date of Application
Select Payment Method


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