MEMBERSHIP FORM
This is a tax invoice ABN 37 191 313 308
Section 1: Individual membership
Title ________ Given name_______________________________ Family name________________________________
School / Institution / Organisation _____________________________________________________________________
Mailing address __________________________________________________________________________________
Suburb/Town ________________________________________ State________________________________________
Postcode __________________________________ Country_______________________________________________
Email address ____________________________________________________________________________________
Phone ___________________________________________ Fax ___________________________________________
Section 2: Institutional membership
Institutional contact: Title ________ Given name__________________Family name___________________________
School / Institution / Organisation _____________________________________________________________________
Mailing address __________________________________________________________________________________
Suburb/Town ________________________________________ State________________________________________
Postcode __________________________________ Country_______________________________________________
Email address ____________________________________________________________________________________
Phone ___________________________________________ Fax ___________________________________________
Section 3: Membership fees
All costs are quoted in Australian dollars (AUD) and include the Australian Goods and Services tax (GST).
Institutional membership p.a: Individual membership p.a.:
$AUD150 Primary and secondary schools, including TAFE Full-time employee, AUD$100
$AUD500 State and regional educational branches Student, AUD$50
Note: 50% discount on individual membership fees for those belonging to an organisation with Universities/tertiary institutions: APFEI institutional membership. Please provide details.
AUD$150 for enrolments up to 2,000
AUD$500 for enrolments up to 5,000
AUD$700 for enrolments between 5,001 and 15,000
AUD$900 for enrolments above 15,000
Section 4: Payment details
All payments must be made in Australian dollars (AUD)
Please debit my Bankcard
Mastercard
Visa
Card number
___ ___ ___ ___ / ___ ___ ___ ___ / ___ ___ ___ ___ / ___ ___ ___ ___
Name on card _______________________________________________ Expiry date __________________________
Signature___________________________________________________ Amount _____________________________
Cheques or money orders should be made payable to the University of South Australia (Asia-Pacific Forum on Educational Integrity) and forwarded to Ms Melissa Ellmers, Finance Officer, School of Management, University of South Australia, GPO Box 2471, Adelaide, SA 5001. Tel: (08) 8302 20573
Fax: (08) 8302 0512, email: [email protected]
