IRef No. A0043555A                                  ARBN: 149 038 719

a student of wushu, tai chi or qigong;
entitled to one vote
Fee: $35.00
With Weapons Exemption: $40.00

This form is not for instructors or organisational 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 reference and include the receipt number in the field below Payment Method If you are renewing your membership please use your invoice number only in the field below Payment Method 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
Name *
Name
Phone *
Phone
Please select one
Payment Method *
Please tick one
I currently practice *
Please tick one or more
I have read and agree to the terms and conditions *
http://
I am seeking cover by WTQA Class Exemption to practice, possess or carry a Wushu or Tai Chi sword
Please tick Yes or 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 pages 3 and 4 of this application
See link below the next question
I agree to comply with the GIC Order requirements, as evidenced by ticking this box below
Click on the link to view the GIC Order requirements
http://
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
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 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 hereby certify that the information provided by me in this application is true and correct.
Please tick