Please complete the form below and send it (with your payment) to :
ASOR Inc. (Melbourne Chapter) P.O. Box 1048H GPO Melbourne 3001
$100 per Institution member $45 per corporate member (A $5 discount applies if you pay before March) $25 per retired member $0 per student member
Grade of Membership Applied for Member Retired Student
First name
Last name
Other name
Unit/Department
Organization
Street
City
State, Postal Code, Country
Telephone
Fax
E-mail
If this is not your first application for membership, give details (on a separate sheet if necessary) of current status of previous application and/or membership, and include name of Chapter
Details of relevant experience
Dates
Employer & Position
Relevant Experience
Details of Qualifications
Year
Institution
Qualification Obtained
Details of Current Studies
Course of Study
Details of two ASOR members who agreed to nominate you
Name
Contact Information
I declare that the information given above is true and correct in all particulars. If admitted to ASOR, I undertake to be bound by the Society's Constitution and By Laws. In payment of my first annual subscription I enclose the sum of $
Signature
Date