Name *

First Name

Last Name

Phone *

(###)

###

####

Payment Method

Please tick one

PayPal portal

EFT

Money order

Cheque

I currently practice

Please tick one or more

Wushu

Tai Chi

Qigong

I have previously submitted my resume.

Yes

I 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

Yes

I am seeking cover by WTQA Class Exemption to practice, possess or carry a Wushu or Tai Chi sword

Please tick Yes or No

Yes

No

I have read, the permissions, purposes and conditions of the Governor in Council (GIC) Order covering the activities involving swords as set out in this application

See link below the next question

Yes (for class exemption applicants only)

I have read and agree to the terms and conditions *

Yes

I agree to comply with the GIC Order requirements, as evidenced by ticking this box below

Yes (for class exemption applicants only)

Option 1: I have sent a statutory declaration stating that I am not a Prohibited Person as defined and as required by the GIC Order? (tick)

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

Yes (for class exemption applicants only)

I have previously submitted my statutory declaration (for class exemption applicants only) (Renewals only)

Option 2: I have sent a Police Check verifying that I am not a Prohibited Person? (tick)

You can chose this option or the one above, 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

Yes (for class exemption applicants only)

I have previously submitted my Police Check (for class exemption applicants only) (Renewals only)

I hereby certify that the information provided by me in this application is true and correct. *

Please tick

Yes