PALS MEMBERSHIP
FORM
Please print, complete and send to PALS, PO Box 325 CONCORD NSW 2137 (ABN 20 110 663 713)
Ms/Mrs/Mr/Dr
Given Name(s) ________________________Family Name___________________________
Home/Postal Address __________________________________________________________________________
_____________________________________________________Postcode______________
Telephone (home)______________________
(mobile )_____________________________
Business/School Address
____________________________________________________________________________________________
_______________________________________________________________________________________________________
Postcode ___________________
Telephone (work
base or best contact) ______________________
Fax________________________
E-mail______________________________________________________________
Level (please tick)
Early Childhood
Primary
Secondary
Tertiary
DET
CEO
AIS
University
Other (please indicate)___________________________________
STLA
Support Teacher
Classroom Teacher
Other (please indicate)
___________________________________
Ordinary
$40.00
Associate
$40.00
Institutions/Corporations
(Can nominate two persons to attend
Seminars)
$60.00
I enclose a cheque for $ _________________(made payable to
PALS) Date___________