Ref No. A0043555A                                  ARBN: 149 038 719

a school or training organisation offering instruction and running
classes in wushu, tai chi and/or qigong;
approved by WTQA
entry on Approved WTQA Instructor Website Listing
entitled to two voting representatives nominated by the school
Fee: Up to 20 students/members: $60.00
With Weapons Exemption: $70.00
More than 20 students/members: $90.00
With Weapons Exemption: $105.00

This form is not for individual practitioner or Individual Instructor memberships

Payment
If paying by EFT or Bank Transfer: Bank: Westpac Banking Corporation Branch: Ashburton BSB: 033106 Account Number: 315036 Account Name: WTQA Please note: Use your initial and surname as a reference and include the receipt number in the field below Payment Method. If you are renewing your membership please use your invoice number as reference in the Payment Method field below If paying by money order or cheque, please make payable to: Wushu Tai Chi and Qigong Australia INC Registration, release forms and payment to be mailed to: Wushu Tai Chi and Qigong Australia INC. PO Box 246, Ashburton, VIC 3147
Phone *
Phone
Representative 1
Representative 1
For new memberships only
Address
Address
Phone 1
Phone 1
Representative 2
Representative 2
For new memberships only
Phone 2
Phone 2
Address 2
Address 2
New members skip this question. If you are renewing your membership you must provide your representative's card numbers
New members skip this question
New organisational members must have a proposer and a seconder
New organisational members must have a proposer and a seconder
Please select one
Payment Method *
Please tick one
I currently practice *
Please tick one or more
Senior or Chief Instructor Details *
Senior or Chief Instructor Details
If you have previously submitted your resume leave this blank and answer the next question.
I have previously submitted my resume.
Please select one
http://
Please select one
Please select one
I/We would like to have class details listed on the WTQA Website
If yes please enter your details in the form at the bottom of the WTQA Instuctors page
I/We am/are seeking cover by WTQA Class Exemption for our members to practise, possess or carry a Wushu or Tai Chi sword
Please tick Yes or No
I/We have read, the permissions, purposes and conditions of the Governor in Council (GIC) Order covering the activities involving swords as set out in the link below of this application. I/We have also read, the additional conditions of the GIC Order applying to Specified Organisations who are Organisation Members of WTQA
See link below the next question
In seeking membership and approval as an Organisation Member of WTQA, I/we agree that the Organisation on whose behalf this application is made, will comply with the GIC Order requirements, as evidenced by the tick below. I/We will also provide all our members who practice, possess or carry a sword a copy of their responsibilities as set out in the link below (CIG order requirements)
Click on the link to view the GIC Order requirements for instructor, practitioners and organisations
http://
Option 1: I/We have attached a statutory declaration stating that I/we and the Organisation members are not a Prohibited Person as defined and as required by the GIC Order
You can chose this option or the one below, you don't need both. Please send documents to membership@wtqa.org.au or Wushu Tai Chi and Qigong Australia Inc. PO Box 246, Ashburton Victoria 3147
Option 2: I/We have attached a Police Check verifying that I/we and the Organisation members am not a Prohibited Person
You can chose this option or the one below, you don't need both. Please send documents to membership@wtqa.org.au or Wushu Tai Chi and Qigong Australia Inc. PO Box 246, Ashburton Victoria 3147
I/We hereby certify that the information provided by me in this application is true and correct. *
Please tick