MEMBERSHIP FORM`

CLUBS WITHIN DISTRICTS
E.Z's Sweet Fantasy
MEMBERSHIP APPLICATION
For faster service, add and pay for your new members online at www.toastmasters.org/members
Club Number: ____________________________ District Number: __________
Club Name: _______________________________________________________ City: _________________________________________
Membership Type:
New
Reinstated (break in membership)
Renewing (no break in membership)
Dual

Transfer from club number /name _______ /___________________ Member Number (if known) __________
_____________________________________________________________________________________________________
Male
Last Name / Surname / Family Name
First Name / Given Name
Middle Initial / Name
Female
______________________________________________________________________________________________________________________________
Address Line 1
______________________________________________________________________________________________________________________________
Address Line 2
______________________________________________________________________________________________________________________________
City
State/Province
Country
ZIP/Postal Code
______________________________________________________________________________________________________________________________
Home Phone Number
Mobile Number
Work Phone Number
______________________________________________________________________________________________________________________________
Email
Please do not send promotions to me from Toastmasters International's partners.
1. NEW MEMBER FEE . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .
U.S. $20.00
EC $25.00
$ ________
New Member Kit
Paid only by new members. Covers costs of the New Member Kit and processing.
preference for
1a. California clubs add 7.75% sales tax ($1.55)
$ ________
new members only:
2. Membership Dues (all members) Begin Date ______________________________
English
Pro-rated at $6.00 per month.
$5.00 fee Every Month
$5.00 Fee on the Last Monday of Every Month.
Month/Year
French
Spanish
October
January
or
April
U.S. $36.00
$ ________
Japanese
November
or
May
30.00
February
Chinese (Traditional)
December
or
June
24.00
March
Chinese (Simplified)
January
April
or
July
18.00
German
February
or
August
12.00
Arabic
March
or
September
6.00
PDF on CD
3. Total of 1, 1a, and 2
$ ________
(visually impaired only)
PAYMENT INFORMATION Choose one:
Selected materials in the new member
kit are available in English only.
Check or money order in U.S. funds drawn on a U.S. bank, or credit card payment, must be included.
[ ] Cash [ ] Check [ ] Credit Card
Line 3 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.
Club Dues Worksheet
Dues and fees are payable in advance and are not refundable or transferable.
For club use oNly
Check:
No. ____________________ Amount $ ________________________
International fees and dues: $ _______
Credit Card: MasterCard Visa AMEX Discover
(from Line 3 on left)
Card No. _________________________________________ Exp. Date ________________
Club New Member Fee:
_______
Signature / Name on Card ____________________________________________________
Club Dues:
_______
Other __________________________________________________________________
Total: $ _______

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New / Reinstated / Dual Member Sponsor: The person who recruited and/or encouraged the member to join.
________________________________________________________________________________________________________________
Last Name / Surname / Family Name
First Name / Given Name
Middle Initial / Name
________________________________________________________________________________________________________________
Sponsor's District Number
Sponsor's Home Club Number
Member Number (if known)
Note: to ENSurE ProPEr CrEdit, thE SPoNSor'S fuLL firSt ANd LASt NAME ANd hoME CLub NuMbEr MuSt APPEAr.
Member's Agreement and Release:
A Toastmaster's Promise
Consistent with my desire to take personal responsibility for my conduct,
As a member of Toastmasters International and my
individually and as a member of a Toastmasters club, I agree to abide by the
club, I promise...

principles contained in "A Toastmaster's Promise" and the governing docu-

To attend club meetings regularly;
ments and policies of Toastmasters International and my club. I will refrain
from any form of discrimination, harassment, derogatory, illegal, or unethical

To prepare all of my speech and leadership
conduct, and I understand that if I engage in such conduct, I may be re-
projects to the best of my ability, basing them
sponsible to reimburse Toastmasters Inter national, my club or other clubs, or
on projects in the Competent Communication,
other individuals involved with Toastmasters, for any damages, losses, or costs
Advanced Communication or Competent Leader-
resulting from my conduct. Understanding that Toastmasters programs are
ship manuals;
conducted by volunteers who cannot be effectively screened or supervised

To prepare for and fulfill meeting assignments;
by Toast masters International or its clubs, I release and discharge Toastmasters
International, its clubs, governing bodies, and representatives from any liabil-

To provide fellow members with helpful, con-
ity for the intentional or negligent acts or omissions of any member or officer
structive evaluations;
of my club or other clubs, or any officer of Toastmasters International.

To help the club maintain the positive, friendly
By submitting this application, I agree to the collection, use and processing of

environment necessary for all members to learn
the personal information I provide to Toastmasters in this Membership Appli-
and grow;
cation for the purposes of organization administration, payment of my dues,

To serve my club as an officer when called upon
and inclusion of my contact information in a members' directory that will be
to do so;
distributed to members and employees of Toastmasters. By submitting my

To treat my fellow club members and our
personal information to Toastmasters, I also agree that my information may be
guests with respect and courtesy;
accessed and used by Toastmasters and its employees and agents, and will be
transferred to countries that are not regarded as having adequate data pro-

To bring guests to club meetings so they can
tection, including to Toastmasters' headquarters in the United States. I agree
see the benefits Toastmasters membership
to notify addresschanges@toastmasters.org of any change to my personal
offers;
information, including making any requests to check, delete or correct my

To adhere to the guidelines and rules for all
personal information, so that it is accurate and current. I understand that the
Toast masters educational and recognition
majority of the data requested in this application is necessary for administra-
programs;
tive and planning purposes, and that the failure to provide this information
may prevent my application from being properly processed or inclusion of

To maintain honest and highly ethical standards
my contact information in the members' directory.

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 applica-
tion contains both the signature of the new member and the signature of a club officer. Questions should be directed to the Membership
department: membership@toastmasters.or
Sweetfantasymembers@gmail.com g.
By my signature below, I agree to the terms of A Toastmaster's Prom
E.Z's Sweet Fantasy
E.Z'S Sweet Fantasy -
By my signature below, I certify that this individual has joined the
ise, and the Indemnifi cation and Release stated above, and certify
Toastmasters club identified. As a club, we will ensure that this
E.Z's Sweet Fantasy
that I am 18 years of age or older, in compliance with the Toastmas-

member receives proper orientation and mentoring.
ters International Club Constitution.
I acknowledge that my electronic signature on this document is
I acknowledge that my electronic signature on this document is
legally equivalent to my hand-written signature.
legally equivalent to my hand-written signature.
Signed: ________________________________________________
Signed: ________________________________________________
APPLICANT
CLUB OFFICER
In order for this application to be valid both signatures are required.
CLUB OFFICER - Please keep a copy for your club's records. If paying online, go to www.toastmasters.org/members, and log in.
If mailing, send to: Membership Records, 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. For fastest results, enter new members online.
Rev 6/2011
Item 400

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