By filling up this form, you wish to be a member of the Grassroots Toastmasters Club and have agreed to pay an one time new member and monthly fees.
(). You will receive a confirmation email within 5 working days upon payment.

Please leave the Bank Account No. field empty if you are paying via other methods. All other fields are mandatory.

Family, Given Name :
NRIC (Username for Account) :
Address:
Postal Code :
Home No. :
Mobile No. :
Fax No. (Optional) :
Email Address :
Membership Status :	New Reinstated Dual Member ()
Member who introduced you (Optional):
Payment Method :	Cash Cheque Account Transfer
Bank Account No :