FORM

3
Charter Membership Application
& Payment Information
Prospective members should follow the instructions provided below for becoming a charter member.
1. Completely fill out and sign the Charter Membership Application.
2. Completely fill out and sign the Payment Information document (page 3).
3. Submit both completed and signed documents to the club coordinator.
4. Please check here if you use assistive technology (such as a screen reader) to view your educational materials.

For questions, please contact [email protected].

MEMBERSHIP APPLICATION
Club Information Membership Type
This section is completed by a club officer New R einstated (break in
_________________________________________________________________________________________ Dual membership)
Club number Club name Club city
T ransfer (If applicant is transferring from ­another
Applicant Information club, please fill in the three lines below.)
This section is completed by the applicant.     Male   Female   Decline to respond
_________________________________________________________________________________________ _______________________________________
Last name/Surname First name Middle name Previous club name

_______________________________________
The monthly Toastmaster magazine will be sent to the following address: Previous club number
_________________________________________________________________________________________ _______________________________________
Organization/In care of Member number
_________________________________________________________________________________________
Address line 1 (limit 35 characters)
_________________________________________________________________________________________
Address line 2 (limit 35 characters)
_________________________________________________________________________________________
City State or province
_________________________________________________________________________________________
Country Postal code
_______________________________________________________________________________________________________________________________________
Home phone number Mobile phone number Email address

Toastmasters International Dues and Fees

This section is completed by the applicant with the help of a club officer. Dues and fees are payable in advance and are not refundable or transferable
from one member to another.
1. New member fee (US$20) US$__________ 2. Membership dues (US$45) US$_________
Paid only by the new members, this fee covers the cost of the first education path,
online copy of The Navigator and processing. 4. Total payment to Toastmasters International 0.00
US$ ________
Total of 1, 2 and 3
3. Renewals (optional)
P ursuant to the Bylaws of Toastmasters International, although you are submitting
6 months of dues at time of charter, Toastmasters clubs are required to remit member-
ship payments semiannually in April and October. Clubs chartering in September or
March may wish to submit their renewal dues now to avoid having to collect dues Club Dues and Fees Worksheet
from each member twice in two months. If your club charters in the months of
­October through March, your next dues renewal is due April 1st. If your club charters Club dues must be paid directly to the club. World Headquarters cannot
in the months of April through September, your next dues renewal is due October 1st. charge credit card payments for club dues.
Based on the month your club charters the amount of dues renewal per member is International Fees and Dues US$ ________________
as follows: (from line 4 above)
DISTRICTED Club new member fee _______________
 October or  April US$45.00 $_________
Club dues _______________
 November or  May 37.50 _________
 December or  June 30.00 _________ Total payment to club 0.00
_______________
 January or  July 22.50 _________
 February or  August 15.00 _________ I want my membership to begin: _________________________________
Month/Year
 March or  September 7.50 _________

HOW TO BUILD A TOASTMASTERS CLUB   23

Member’s Agreement and Release
Consistent with my desire to take personal responsibility for my conduct, individually and as a member of a Toastmasters club, I agree to abide by the principles
contained in “A Toastmaster’s Promise” and the Toastmasters International Governing Documents and my club. I will refrain from any form of discrimination,
harassment, bullying, derogatory, illegal, or unethical conduct, and I understand that if I engage in such conduct, I agree to reimburse Toastmasters International, my
club or other clubs, or other individuals involved with Toastmasters, for any damages, losses or costs resulting from my conduct. Understanding that Toastmasters
programs are conducted by volunteers who cannot be effectively screened or supervised by Toastmasters International or its clubs, I release and discharge
Toastmasters International, its clubs, governing bodies, officers, employees, agents, and representatives from any liability for the intentional or negligent acts or
omissions of any member or officer of my club or other clubs, or any officer of Toastmasters International. Should a dispute of some nature arise, I expressly agree to
resolve all disputes, claims, and charges relating to Toastmasters, districts, clubs, and Toastmasters members in accordance with Protocol 3.0: Ethics and Conduct.
By submitting this application, I expressly agree to the following:
The collection, use and processing of the personal information I provide to Toastmasters in this membership application for the purposes of organization administration, payment
of my dues, and inclusion of my contact information in a members’ directory that will be distributed to members and employees of Toastmasters. In addition, the collection, use
and processing of my personal information collected by Toastmasters International through Toastmasters' website and by electronic communications.
That my information may be accessed and used by Toastmasters, its employees and agents, district officers, and club officers.
Maintain changes to my personal contact information to ensure it is accurate and current by updating my personal profile page located on the Toastmasters International website
www.toastmasters.org\login. I understand that the majority of the data requested in this application is necessary for administrative and planning purposes.
Occasionally we would like to contact you with details of services, educational updates, and organizational updates. If you consent to us contacting you for this
purpose, please check the box below corresponding to acceptable contact methods: Mail Email Phone
If you would rather not receive non-essential communications from us, please check here
For our full privacy policy, you may visit www.toastmasters.org/footer/privacy-policy.

Verification of Applicant
A Toastmaster’s Promise
By my signature below, I agree to the terms of A Toastmaster’s Promise and the
As a member of Toastmasters International and my club, I promise Member’s Agreement and Release stated above and certify that I am 18 years
 To attend club meetings regularly
of age or older, in compliance with the Toastmasters Club Constitution for
Clubs of Toastmasters International.
 To prepare all of my projects to the best of my ability, basing
I acknowledge that my electronic signature on this document is legally equiva-
them on the Toastmasters education program
lent to my handwritten signature.
 To prepare for and fulfill meeting assignments
����������������������������������������������������������������
 To provide fellow members with helpful, constructive Applicant’s signature Date
evaluations
 To help the club maintain the positive, friendly environment
Verification of Club Officer
necessary for all members to learn and grow
I confirm that a complete membership application, including both the signature
 To serve my club as an officer when called upon to do so of the new member and that of a club officer, is on file with the club and will be
 To treat my fellow club members and our guests with respect retained by the club.
and courtesy By my signature below, I certify that this individual has joined the Toastmasters
 To bring guests to club meetings so they can see the benefits
club identified. As a club, we will ensure that this member receives proper
Toastmasters membership offers orientation and mentoring.
I acknowledge that my electronic signature on this document is legally
 To adhere to the guidelines and rules for all Toastmasters
equivalent to my handwritten signature.
education and recognition programs
 To act within Toastmasters' core values of integrity, respect, ����������������������������������������������������������������
service and excellence during the conduct of all Toastmasters Club Officer's signature Date
activities
In order for this application to be valid, both signatures are required.

CLUB OFFICER
Please keep a copy for your club’s records. Questions should be directed to the New Clubs department: [email protected].

Rev 2/2019 Item ATO-3

24   HOW TO BUILD A TOASTMASTERS CLUB

The club officer must follow the instructions below once the Charter Membership Application and Payment Information d­ ocuments are
received.
1. Sign and date the applicant’s Charter Membership Application.
2. Submit the Charter Membership Application and Payment Information documents to the club coordinator.
3. After receiving confirmation that Toastmasters International has received and processed the Charter Membership Application and Payment
Information, the club coordinator must:
a. Retain the applicant’s Charter Membership Application with other club charter documentation
b. Submit all completed charter documents and payments to the New Clubs team using one of the methods below:
Email:  [email protected]
Fax:  +1 303-799-7753
Mailing Address:  9127 South Jamaica Street, Suite 400 • Englewood, CO 80112 • USA

PAYMENT INFORMATION

Payment Method to Toastmasters International

This section is completed by the applicant and is for payment to World Headquarters only (the amount listed in line 4 on page 1). World Headquarters
does not collect club dues.

MasterCard C
 heck or money order
Check or money order must be for U.S. funds drawn on a U.S. bank.
Visa

AMEX US$____________________________________________________
Amount
Discover
______________________________________________________
Check or money order number
US$____________________________________________________________
Amount

______________________________________________________________
Card number
Other
______________________________________________________________
Expiration date ______________________________________________________
Other
______________________________________________________________
Name on card

______________________________________________________________
Signature
I acknowledge that my electronic signature on this document is legally
equivalent to my handwritten signature.

HOW TO BUILD A TOASTMASTERS CLUB   25