Toastmaster Membership Application

FORM
Charter Member Application

Club number (if known): _____________________ District number: _____________
Club name: _____________________________________________________________________ City: ____________________________________
Membership type:
New
Reinstated (break in membership)
Dual
Transfer from club number/name _________ /___________________________ Member number (if known) _________
_____________________________________________________________________________________________________________________
Last Name / Surname
First Name
Middle Name
Female
Male
The Toastmaster magazine will be sent to the following address:

_____________________________________________________________________________________________________________________________________________________
Company / In Care Of
_____________________________________________________________________________________________________________________________________________________
Address 1 (Limit 35 characters)
_____________________________________________________________________________________________________________________________________________________
Address 2 (Limit 35 characters)
_____________________________________________________________________________________________________________________________________________________
City
State or Province
Country
Postal Code
_____________________________________________________________________________________________________________________________________________________
Home Phone
Mobile Phone
Work Phone
__________________________________________________________________________
Email address
Please do not send promotions to me from Toastmasters Internationals partners.
1. NEW MEMBER FEE . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . U.S. $20

$ ____________
New Member Kit
Paid only by new members. Covers costs of the New Member Kit and processing.
preference:
1a. California clubs add 8% sales tax ($1.60) $
____________
English
2. Membership Dues ($36 or $27 if undistricted)
$ ____________
Arabic
3. R
enewals (optional)
Simplified Chinese
P ursuant to the Bylaws of Toastmasters International, although you are submitting 6 months of dues at time of
Traditional Chinese
charter, Toastmasters clubs are required to remit membership payments semiannually in April and October. Clubs
chartering in September or March may wish to submit their renewal dues now to avoid having to collect dues from
French
each member twice in two months. If your club charters in the months of October through March, your next dues
German
renewal is due April 1st. If your club charters in the months of April through September, your next dues renewal is
Japanese
due October 1st. Based on the month your club charters the amount of dues renewal per member is as follows:
Spanish

DISTRICTED UNDISTRICTED
A

ccessible PDF on CD
October or April
U.S.$36.00 $___________ U.S. $27.00 $ __________
for the visually impaired
November or
May
30.00 ___________
22.50 __________
(English only)
December or
June
24.00 ___________
18.00 __________
Selected materials in the new member
January or July
18.00 ___________
13.50 __________
kit are available in English only.
February or August
12.00 ___________
9.00 __________
March
or September
6.00 ___________
4.50 __________
0.00
4. Total of 1, 1a, 2, and 3
$ ____________
PAYMENT INFORMATIONChoose one:
Check or money order in U.S. funds drawn on a U.S. bank payable to Toastmasters International, or credit
card payment, must be included. Line 4 is the amount payable to Toastmasters International.
Note: Your club may also charge dues to meet club expenses. Unfortunately, WHQ is unable to
charge club dues on the credit card submitted. Club dues must be paid directly to the club.
Dues and fees are payable in advance and are not refundable or transferable.
Check or money order:
Credit Card:
Check or money order number__________________ Amount U.S.$___________
MasterCard Visa American Express
Discover
Amount U.S.$ ___________
Club Dues Worksheet

FOR CLUB USE ONLY
International
fees and dues: $ ___________
(from Line 4
on left)
Club New
Member Fee: ___________
Card number _________________________________________ Expiration date___________________
Club Dues: ___________
Name on card____________________________________ Signature__________________________________
Total:
0.00
$ ___________
Other ___________________________________________________________________________
HOW TO BUILD A TOASTMASTERS CLUB17
Members Agreement and Release:

Consistent with my desire to take personal responsibility for my conduct,
individually and as a member of a Toastmasters club, I agree to abide by the
principles contained in A Toastmasters Promise and the governing documents
and policies of Toastmasters International and my club. I will refrain from any
form of discrimination, harassment, derogatory, illegal, or unethical conduct,
and I understand that if I engage in such conduct, I agree to reimburse
Toastmasters International, my club or other clubs, or other individuals involved
with Toastmasters, for any damages, losses, or costs resulting from my conduct.
Understanding that Toastmasters programs are conducted by volunteers who
cannot be effectively screened or supervised by Toastmasters International or
its clubs, I release and discharge Toastmasters International, its clubs, governing
bodies, officers, employees, agents and representatives from any liability for the
intentional or negligent acts or omissions of any member or officer of my club or
other clubs, or any officer of Toastmasters International.
By submitting this application, I agree to the collection, use and processing
of the personal information I provide to Toastmasters in this Membership
Application for the purposes of organization administration, payment of my
dues, and inclusion of my contact information in a members directory that will
be distributed to members and employees of Toastmasters. By submitting my
personal information to Toastmasters, I also agree that my information may
be accessed and used by Toastmasters and its employees and agents. I agree
to notify [email protected] of any change to my personal
information, including making any requests to check, delete or correct my
personal information, so that it is accurate and current. I understand that the
majority of the data requested in this application is necessary for administrative
and planning purposes, and that the failure to provide this information may
prevent my application from being properly processed or inclusion of my
contact information in the members directory.
A Toastmasters Promise
As a member of Toastmasters International and my
club, I promise
To attend club meetings regularly
To prepare all of my speech and leadership projects
to the best of my ability, basing them on projects
in the Competent Communication, Advanced
Communication, or Competent Leadership manuals
To prepare for and fulfill meeting assignments
To provide fellow members with helpful,
constructive evaluations
To help the club maintain the positive, friendly
environment necessary for all members to learn
and grow
To serve my club as an officer when called upon
to do so
To treat my fellow club members and our guests
with respect and courtesy
To bring guests to club meetings so they can see
the benefits Toastmasters membership offers
To adhere to the guidelines and rules for all Toast
masters education and recognition programs
To maintain honest and highly ethical standards
during the conduct of all Toastmasters activities
I confirm that a completed new member application for this member is on file with the club and will be retained by the club. The application
contains both the signature of the new member and the signature of a club officer. Questions should be directed to the New Clubs department:
[email protected].
By my signature below, I agree to the terms of A Toastmasters Promise,
and the Member's Agreement and Release stated above, and certify that
I am 18 years of age or older, in compliance with the Club Constitution
for Clubs of Toastmasters International.
I acknowledge that my electronic signature on this document is legally
equivalent to my hand-written signature.
Signed: __________________________________________________________
APPLICANT
By my signature below, I certify that this individual has joined the

Toastmasters club identified. As a club, we will ensure that this m
ember
receives proper orientation and mentoring.
I acknowledge that my electronic signature on this document is legally
equivalent to my hand-written signature.
Signed: _________________________________________________________
In order for this application to be valid both signatures are required.

CLUB OFFICER Please keep a copy for your clubs records. If mailing, send to:
New Clubs, Toastmasters International, P.O. Box 9052, Mission Viejo, CA 92690 USA.
If faxing, send to: 949-858-1207.
Note: Please submit information via one method only to avoid duplication.
18HOW TO BUILD A TOASTMASTERS CLUB
CLUB OFFICER

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FORM

Charter Member Application

Reinstated (break in membership)

The Toastmaster magazine will be sent to the following address:

Please do not send promotions to me from Toastmasters Internationals partners.

1. NEW MEMBER FEE . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . U.S. $20

Check or money order number________ Amount U.S.$_

MasterCard Visa American Express

Amount U.S.$ ___________

Club Dues Worksheet

Card number _______________________ Expiration date_

Club Dues: ___________

Name on card__ Signature

Members Agreement and Release:

By my signature below, I certify that this individual has joined the

In order for this application to be valid both signatures are required.

18HOW TO BUILD A TOASTMASTERS CLUB

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