2021 JLTAV School Membership Application Form
Please note: If there is only one teacher of Japanese at a school, please fill in "Individual Membership Form"
The Japanese Language Teachers' Association of Victoria Inc.
LPO Box 8157, 12 Ancora Imparo Way, Monash University VIC 3800
Date: email date
ABN 29 370 901 218
1. Complete this online form, and submit it. Ensure that both email addresses are correct.
2. Print it before you press "SUBMIT". This application form becomes a TAX INVOICE for the payment purpose for your school. (This will also be emailed to you.)
3. EFT to BSB 033-034 A/C# 61-1599
Account name: Japanese Language Teachers Association of Victoria Inc
(Please send payment advice to
. No paper advice required.)
Payment enquires to:
Sign in to Google
to save your progress.
Confirm email address
Contact person's name
Usually the Japanese coordinator.
Select membership category
All fees include GST. Amounts in ( ) show early bird rate, apply if received by 28/2/21)
Schools up to 2 teachers (regardless of time fraction) - $145.00 ($130.00)
Schools with 3 or more teachers (regardless of time fraction) - $230.00 ($200.00)
School Purchase Order Number (if applicable)
If you don't work for a school, write CRT, Tutor or Student.
Regional (over 60 km from Clayton)
School or home street address
School or home suburb/town and state
In capital letters, e.g. CLAYTON VIC
School or home postcode
School telephone number or your mobile number
Without spaces, e.g. 0399058791
Japanese teachers to receive accounts
Do not include the main contact, whose details were given above. Please type their names and email addresses correctly.
Teacher 1 name
Teacher 1 email
Teacher 2 name
Teacher 2 email
Teacher 3 name
Teacher 3 email
Teacher 4 name
Teacher 4 email
Teacher 5 name
Teacher 5 email
If you have additional teachers, please put their names in the text below. Please type their name on one line and their email address on the next. Repeat on new lines for any additional teachers.
Please check before submitting
1. Double-check this form.
2. Don't forget to click SUBMIT after printing. Click only ONCE.
3. Membership is accepted when we receive the payment.
4. A confirmation email will be sent to the email address you specified immediately. Please check your inbox for notification to ensure you entered your details correctly. Check spam folders if necessary.
5. If you did NOT receive a confirmation email, you either did not complete the form or entered your email address incorrectly. This will likely mean you are not registered.
6. You MUST resubmit the form if you did not receive a confirmation email within five minutes.
A copy of your responses will be emailed to the address you provided.
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