Membership D: Individual Membership Subscription

Please enter information on the form below to process subscription for Membership D: Individual Membership.

Email *

Password*

Retype Password *

Title

First Name *

Last Name *

Institution Name *

Address *

Address2

City *

Country *

State *

Postcode *

Phone

Purchase Order No. (if required by school)

Current Role *

FT, PT or Retired *

Tick All Languages Taught

Chinese

French

German

Indonesian

Italian

Japanese

Other

Specify Other Languages

Teacher Experience: Years *

Language-Specific Association:

Individual Member + Language-Specific Association:

Yes

Number of Languages:

Specific Language:

Netzwerk (German)

Pergubit (Indonesian)

AFMLTA (National) Communications List.

AFMLTA (national) communications list *

I agree to the mltat providing my name and email address to the AFMLTA (national) communications list.

Payment:

Once payment has been received an Invoice/Receipt will be sent to your nominated email address for your bursar or accounts department.

School Region *

Northern

North-west

Southern

Region - other

Payment Information

Price

Payment Method

Offline Payment

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

I accept Terms and Conditions

Membership D: Individual Membership Subscription

Existing user? Please login

New User? Please register

Account Information

Language-Specific Association:

AFMLTA (National) Communications List.

Payment:

Payment Information

Affiliated with: Australian Federation of Modern Language Teachers Associations.