ACT Fencing Association Inc

ACTFA 2010 Online Membership Form

Welcome to the online membership form for the ACT Fencing Association.

Important: This form can only be used to register members over the age of 18. If you are under the age of 18, or are registering someone that is under the age of 18 then you need to download the printable form from the menu to the left.

Please be aware that you do not become a member of ACTFA by simply filling in this form,
you will need to pay money either via direct Deposit, or in person to the ACTFA Treasurer.

There are 4 stages in this process

Personal Details
Membership Details
Declaration
Payment Details

Membership Fees for 2010 are as follows:

Level	Cost
Senior Affilated	$105.00
Junior Affilated	$65.00
Non Club Levy	$25.00
Non Fencing Member	$35.00
Coaches (Fencing)	$65.00
Coaches (Non fencing)	$55.00
Beginners Registration	$30.00

Please click the "Next Page" button below to enter you details.

Surname:

Please enter your Personal Details

Given Name:

Address:

Suburb:

Post Code:

Email Address:

Reenter email:

Contact Phone:

Gender:

(Mobile Prefered)

Please identify your weapons?

Date of Birth

(DD/MM/YYYY)

Club:*

Foil

Epee

Sabre

Select the "Next Page" button to select you membership level.

* Note: Your club membership will be verified before Membership is granted.

Do you have any medical conditions that ACTFA should be aware of?

Please select your level of Membership

Membership Options

Affiliated Senior

For Fencers that are 20 years or older on the 1st Jan 2010

$105.00

Affiliated Junior

For Fencers under 20 years of age as of the 1st Jan 2010

$65.00

Coach (Fencing) #

For Coaches that want to fence in Competitions

$65.00

Coach (Non Fencing) #

For Coaches that do not fence in Competitions

$55.00

Non Club Levy

Additional levy to above memberships for Non club fencers

$25.00

Beginners Registration

Insurance registration only - 3 months duration

$30.00

For Members that do not Fence or Coach

Non-Fencing Member

$35.00

Yes

# Copy of your current Australian Sports Commission Coaches Registration Card must be
sighted by your Club delegate, or ACTFA Committee Member.

Yes

Unless specified, memberships expire on the 31st Dec 2010

Select the "Next Page" button to Review the Declaration.

I agree to ACTFA sending me emails relating to ACTFA and fencing in general.

I agree to allow any photos taken of me at fencing events to be used for promotional purposes of ACTFA and affiliated clubs.

Please read the following Declaration

INDEMNITY DECLARATION

By submitting this form, and paying the amount due, I hereby agree that the ACT Fencing Association Inc., and the Australian Fencing Federation Inc., or any member thereof and/or any person associated in any way with the conduct of or participation in the competitions conducted by said Association or Federation (all of which persons, Association and Federation are severally and jointly included in the term "indemnified") shall not be deemed responsible or liable in any way for any injury, illness, or mishap to me sustained in, arising from or out of, or in any way directly, or indirectly connected with any travelling, match, practice or any function of whatsoever nature held in connection with competitions arranged by the "indemnified", or prior to or subsequent thereof, if in any way connected directly or indirectly with the said competitions and hereby indemnify the indemnified against any actions, suits, courses in action, demands and claims made by me.

I declare that I have read and understand the FIE Rules which apply to all levels of training and competition which come under the auspices of the affiliated clubs, associations of the Australian Fencing Federation Inc., and the Federation itself

Further Declaration:

I understand the conditions of Affiliation / Beginners Registration and agree to abide by the rules and to follow the safety regulations of the FIE (Federation Internationale d'Escrime), the AFF (Australian Fencing Association) and the ACT Fencing Association.

I agree to allow my personal details provided here to be passed onto the AFF and FIE as required.

I agree to submit to any lawful reasonable drug test ordered by an authorised body and agree to comply with AFF and FIE Rules relating to drug testing and the penalties set out therein.

Check here to indicate that you have read, understood and are willing to make this declaration.

Select the "Next Page" button to see you payment options.

Your Payment options

Payments can be made via :

1. Direct Deposit to BSB 062 903 Account 0090 3664 Name: ACT Fencing Association Inc. Put only your name in the reference Field.	2. Cheque payments can be sent to ACT Fencing Association P.O. Box 674 Jamison Centre ACT 2614
Or 3. Cash or Cheque Payments in person to the treasurer of ACTFA (Gordon Christie). Cheques should be made out to "ACT Fencing Association".