Global Learning Communities - Colleagueship

APPLICATION FORM

YOUR OPTIONS:

  1. Complete and submit on-line
  2. Print a copy, complete and Fax to us on: 03 6331 7376
  3. Print a copy, complete and mail to us at: 163 George St, Launceston, Tasmania 7250
Please check Application Type:

Individual Small School Large School District

Title: Name:

HOME DETAILS:

Home Address:

Home Phone:

Home Fax:

Home E-Mail Address:

WORKPLACE DETAILS:

Work Address:

Phone:

Work Fax:

Work E-Mail Address:

 

FEES: Joining Fee ~ $20 (once only) Plus:

Individual:

$50 per year

School (to 6 fulltime teaching staff)

$190 per year

School (6 or more fulltime teaching staff)

$290 per year

District

$390 per year

Your Credit Card Details:

 

Please debit my:  the sum of: $

Name on card: Expiry date:

Card Number: