Phone: 1300 780 017

Dance, Fun and Friendship

ABN: 79 623 300 580

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ACA New Membership Application

Field Shading:
Light red shading means you must complete this field. Data in some fields must obey formatting rules. Light red shading means the form will not accept the present value. Light green shading means the form will accept the value you have entered.

Field Placeholders (blue italics) in empty text fields give clues as to the format of the information required.

I, the person described below, 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. In the event of my admission as a member, I agree to be bound by the Constitution of the Association for the time being in force.
Name Firstname* Lastname*
Preferred name only if different to your first name.
Country of Residence
*The ACA welcomes members from anywhere. If your country is not listed, please request it from the webmaster.
AddressStreet address* Suburb/Town*
State* *
* 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.
Enter your area code then your 'phone number. Do not enter your country code and do not use spaces, dashes or brackets, only digits 0-9.
Home: Business: Mobile: Fax:
Enter your personal email address. It cannot be the same as any other member - all member emails must be unique.
Your ACA Newsletter & all notifications will be distributed electronically.
Tick here to receive hardcopy newsletters.
Date of BirthExcept for Junior applicants (under 18), providing your DOB is optional for all applicants. Juniors must give the full birthdate including year. Other applicants may leave this out altogether, but they are encouraged to at least show the day and month, so we can celebrate your birthday.
Day Month Year
Membership Category*
Choose one of these categories...
Individual ( $20 per year )
Principal ( $30 per year )
Junior ( $10 per year )
Principals are the nominated member of a Family Group.
  • Junior members must be under 18 years of age on 01July when payments are due.
  • To select Junior, you must first complete the Date of Birth information.
  • The indicated fees are due immediately on submission of this application.
  • Members designated as Leaders must hold an Individual membership or be Principals of a Family Group
  • All fees are expressed in Australian Dollars AUD
Family MembershipsEnter 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. If you include family members here, your membership category will be Principal regardless of your selection above.
   Date of Birth (guidelines as for principal member)
First NameLast NamePreferred NameDayMonthYear
ClubsI am a member of the following Clogging Clubs:- (Select up to 3 clubs here.)
Membership YearRead Only
  • 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.
Privacy PolicyThe 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.

Choose a Payment Option (Direct Debit preferred)

Click the radio-button to select how you will pay...

Direct Debit

Browse to your bank's website and make an external transfer to Australian Clogging Association Inc

  • BSB: 062139
  • Account: 10085313
  • Reference: shown next page
Be sure to show the Reference in your transaction so we know who the payment is from! Press the button below to register your payment and see your assigned Reference Number.

If you pay by Direct Debit there is no need to post your form in, as long as you have shown the Reference Number.

Credit Card

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.

Please check that all the above information is correct, then click the Submit Application button below.

After you click the Submit Application, a Payment Slip will appear which you can print and (if necessary) complete and post in with your fee remittance.

Your membership is not final until the payment is received and your membership approved. You will receive three emails

  1. to acknowledge this application
  2. a receipt for payment
  3. a welcome letter which will contain your login credentials
This may take a week or so. Please be patient.