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 *

First Name *

Last Name *

Gender *

Address line 1 *

Address line 2

City *

State *

Postal Code *

Phone Number *

Email Address *

Date Membership began *

New Member Fees ($25)

Applies to first-time members only.

Based on your start date, the appropriate membership period is selected.

October or April $92.00 November or May $76.67 December or June $61.33 January or July $46.00 February or August $30.67 March or September $15.33

Pre-pay next 6-month period (+$92)

Useful if your current membership period ends soon.

This will add a full 6-month membership period ($92) to your total.

Total Membership Dues $0.00