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* Mandatory Elements
Salutation Mr Miss Mrs Ms Dr other
* Given Names:
* Family Name:
* Street Address 1:
Street Address 2:
* Suburb:
* Postcode:
Phone:
* Mobile:
* Email:
* Your ID Number:
* Current Site
* Region:
* Position: Select... Principal Deputy Principal Assistant Principal Senior Leader Preschool or Kindergarten Director Regional Director Assistant Regional Director Manager, Regional Support Services Other
Title:
Previous leadership position: yes no
* Date Tenure concludes:
I hereby apply for membership of the South Australian State School Leaders Association and understand that if my application is accepted, my membership will be effective from the date of the first payroll deduction. I certify that the information I have provided above is accurate.
PAYROLL DEDUCTION AUTHORITY: Following the approval of my application for membership by the Board of the South Australian State School Leaders Association I authorise a payroll deduction of $16.00 per fortnight to be paid to the South Australian State School Leaders Association account at Credit Union SA. I understand that my membership will not be effective until the first payroll deduction, and that this deduction may be increased in future years to an amount in proportion to any increase in the annual membership fee set each year at the Annual General Meeting.
I Agree Date:
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