Associate Membership Enrolment Form

    Your Details

    Please fill in your details below. All fields are required:

    Associate Membership Information

    Annual Associate Membership fees:
    - Single ($10).
    - Family ($15) 1-2 parents and up to 3 children under 18.

    Memberships and class to be approved by ECH Committee of Management per Association Rules.
    Please note that any course enrolment fees are in addition to membership fees.

    NOTE: This form is intended for an Associate Membership (and any associated course enrolments).
    Contact ECH to inquire with regards to Full Membership eligibility and requirements.

    Payment information and instructions are outlined towards the bottom of this form.

    Enrolment Details

    This section contains information related to enrolment.
    If you are not enroling in any sessions, you do not need to fill in this section.

    Please provide details of any courses you wish to enrol (If any):

    Course #1 (leave blank if not required)

    Course #2 (leave blank if not required)

    Course #3 (leave blank if not required)

    Payment Options

    A reminder for payments that fees will need to include the annual membership fee along with all course fees owing.

    There are a number of ways to pay. Please nominate your method of payment (required):

    Our Details

    Emerald Community House is located at:
    Street Address: 356-358 Belgrave-Gembrook Road, Emerald Victoria 3782
    Postal Address: PO Box 328, Emerald 3782
    Phone: 03 5968 3881

    Acceptance and Agreements

    ECH Association Rules are available on the ECH Website:
    In order to process this application, you must understand and tick both check boxes below: