Queen City Toastmasters Club

Membership Application

To become a club member, please completely fill out and sign this Membership Application and the Payment Information.

* Indicates required question

Membership Type

Membership Type *

Applicant's Information

First Name *

Last Name *

Gender *

Address line 1 *

Address line 2

City *

State *

Postal Code *

Phone Number *

Email Address *

Membership Dues

Date Membership began *

New Member Fees

New Member Fees ($25)

Membership begins:

October or April ($80) November or May ($66.67) December or June ($53.33) January or July ($40) February or August ($26.67) March or September ($13.33)

Total Membership Dues

$0.00

Queen City Toastmasters Club

Membership Application

Membership Type

Transferring from another club

Applicant's Information

Membership Dues