Phone: 1300 780 017
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Home >> ACA Information >> New Membership Application
ABN: 79 623 300 580
This is a multi-step form. Complete each step before you move onto the next.
Preferred Name...only if different to your first name
# State...Queensland New South Wales Australian Capital Territory Victoria South Australia Western Australia Northern Territory Tasmania
# State, Province or Region...
# Postcode / Zipcode...
# Street Address...
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Telephone...# at least one
You have to provide at least one home, business or mobile 'phone number, but it doesn't matter which type, and the others can be left empty.
No spaces, dashes or brackets. For Australian applicants, enter your area code first, 10 digits in total, e.g. 0419000000. For overseas applicants, enter + then your country code, then your area code (no starting 0) and then your phone number.
Enter your personal email address. It cannot be the same as any other member - all member emails must be unique.
By default, your ACA Newsletter & all notifications will be distributed electronically. Tick here to receive hardcopy newsletters and notifications instead of by email.
I am a member of the following Clogging Clubs(Select up to 3 clubs here.)
Select additional club50 Plus CentreAdelaide Bluegrass CloggersBarrier Reef CloggersBarwon Valley CloggersBayside CloggersBlue Heeler CloggersCairns City CloggersCane Country CloggersCapital CloggersCassino CloggersCentre CloggersCHUG-A-LUG CLOGGERSCity West CloggersCoastal CowboysCoral Reef CloggersCountry CloggersCowboy Culture CloggersCQ CloggersCradle Coast CloggersDance UniqueDarwin CloggersDixie Doozle CloggersDouble Jingle CloggersEast Coast PrecisionEZ CloggersGold Coast CloggersGolden City CloggersGoody2shoesHazelwood Wild Dog CloggersHillbillies CloggersHooked On CloggingiClog4U3AJo-King CloggersKaye`s CloggersMoonshine CloggersMornington CloggersNelson Sun City CloggersNewcastle CloggersParadise CloggersRhythm CloggersRockingham CloggersRT CloggersSeahorse CloggersSeaside CloggersSilver Soles Cloggers IncSouth Coast StompersStrictly CloggersSun City CloggersSunstate CloggersSyncopatin` CloggersTamar CloggersTassie CloggersWombat Forest CloggersYass Country Cloggers
Getting personal, we know, but we ask for this information just so we can celebrate your birthday each year. Except for Junior applicants (under 18), providing your DOB is optional. Juniors # must give the full birthdate including year. Other applicants may leave this out altogether, but you are encouraged to at least show the day and month, so we know when your birthday is.
Day 012345678910111213141516171819202122232425262728293031 Month -Select-JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year -Select-2020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921
Choose one of these Membership Categories...Individual ( $20 per year )Principal ( $30 per year )Junior ( $10 per year )
Individual membership is for most applicants, but Principals are the nominated head of a Family Group.
Enter details of up to 4 family members here. Family members must be the immediate family of the Principal member detailed above and all must be living at the same address. A couple is determined to be two people who are in a relationship regardless of gender.
Date of Birth: Guidelines as previously.
Membership Year :
The membership year is 01 July to 30 June, regardless of when you join. All rates are annual, there is no pro rata reduction for part years. New memberships approved after 1 January will be current to 30 June of the following year.
# Click the radio-button to select how you will pay...
Direct Debit (Preferred)
Browse to your bank's website and make an external transfer to Australian Clogging Association Inc
If you pay by Direct Debit there is no need to post your form in, as long as you have shown the Reference Number.
Visa and Mastercard only. If you select this option, press the button below and print off a Credit Card form to complete and post it to The Treasurer, Australian Clogging Association, PO Box 775 CO667, Cherrybrook, NSW, 2126
Make cheques payable to Australian Clogging Association Inc. Endorse the back of the cheque with your Reference Number which you will see on the next page. Press the button below and print off a form to complete and post to The Treasurer, Australian Clogging Association, PO Box 775 CO667, Cherrybrook, NSW, 2126. Do NOT send cash through the mail!
Press the button below to register your provisional payment and to print a form which you can post in with your payment confirmation. You will also be sent a copy of the form by email.
When you are satisfied that all the information is complete and correct, then click the Submit Application button below.
After you click it, a Payment Slip will appear which you can print and (if necessary) complete and post in with your fee remittance.
Note: Your membership is not final until the payment is received and your membership approved. You will receive three emails
I hereby apply to become a member of the Australian Clogging Association Incorporated. I understand that payment of the required fee is due immediately on submission of this application. By ticking this box, I agree to be bound by the Constitution of the Association for the time being in force.
The ACA collects personal information for the purpose of administering your membership. The information collected is limited to that shown in membership application form and what is subsequently appended by yourself or the ACA regarding payments, accreditation and merchandise purchases. When you login to the Members Only area of the ACA website, the time, date and IP address of your server are recorded in a log for security purposes. The ACA will not release any of your information to any organisation or person unless you give permission. Your information is kept in secured databases. The ACA does not collect or save credit card or bank account information. The ACA transmits regular newsletters and occasional communications to your email or postal address and your application for membership is an explicit agreement to receive such communications. The ACA website does not post cookies on your computer or device. When you terminate your relationship with the ACA, you have the right to request removal of all identifying details from the database.