Institutional Membership of AUUG Inc.
Application & Tax Invoice
AUUG Incorporated - ABN 15 645 981 718
Use this invoice to apply for, or renew, institutional membership of AUUG Inc. A different form should be used to apply for ordinary membership, student membership or a newsletter subscription.
To apply for institutional membership of AUUG Incorporated, please print out this invoice, complete it, and return it to the Treasurer. AUUG does not publish the private contact details for its officers; please send email to treasurer@auug.org.au requesting the current treasurer's address.
- Please do not send purchase orders -- payment must accompany this invoice.
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Foreign applicants:
- Please note that all amounts quoted are in Australian Dollars.
- Please send a bank draft drawn on an Australian bank, or credit card authorisation.
Section A: Member Details
The primary contact holds the voting rights for this institutional member, and two designated representatives (one of whom may the the primary contact) will be given membership rates to AUUG activities including chapter activities. In addition to the two representatives, additional representatives can be added at a cost of $100 each (including GST).
NAME OF ORGANISATION: _______________________________________________________
Primary Contact:
Surname: _______________________ First Name: ___________________________ Title: _______________________ Position: ___________________________ Address: ________________________________________________________________ Suburb: __________________________ State: ________ Postcode: _________ Telephone: Business: ________________ Private: ___________________________ Facsimile: __________________________ E-mail: ___________________________
Representative 1:
Surname: _______________________ First Name: ___________________________ Title: _______________________ Position: ___________________________ Address: ________________________________________________________________ Suburb: __________________________ State: ________ Postcode: _________ Telephone: Business: ________________ Private: ___________________________ Facsimile: __________________________ E-mail: ___________________________
Representative 2:
Surname: _______________________ First Name: ___________________________ Title: _______________________ Position: ___________________________ Address: ________________________________________________________________ Suburb: __________________________ State: ________ Postcode: _________ Telephone: Business: ________________ Private: ___________________________ Facsimile: __________________________ E-mail: ___________________________
Please attach a seperate sheet with details of any additional representatives.
Section B: Price
Please tick the box to apply for institutional membership. Please indicate if international air mail is required.
| Renew/New* Institutional Membership |
|
$480.00 (including $43.64 GST) | ||
| Additional Representatives | Number |
|
100.00 each (including $9.09 GST) | |
| Surcharge for International Air Mail |
|
$120.00 |
* Delete as appropriate.
GST only applies to institutions in Australia. Rates valid from 1st July 2000.
Section C: Mailing Lists
AUUG mailing lists are sometimes made available to vendors. Please indicate whether you wish your name to be included on these lists:
|
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Yes |
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No |
Section D: Payment
Please do not send purchase orders. Payment is required with this invoice.
Pay by cheque
Cheques to be made payable to AUUG Inc. Payment in Australian Dollars only.
For all overseas applications, a bank draft on an Australian bank is required.
OR
Pay by credit card
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|
Please debit my credit card for A$____________ |
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Visa |
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Mastercard |
Name on Card: _________________________________________________________ Card Number: __________________________________________________________ Expiry Date: __________________________________________________________ Signature: ____________________________________________________________
Section E: Agreement
I agree that this membership will be subject to rules and bylaws of AUUG as in force from time to time, and this membership will run from the time of joining/renewal for 12 months.
Signed: _______________________________________________________________
AUUG Secretariat Use Only
Chq: bank _________ bsb _____-_____ a/c ________________ # _________________ Date: ________ $ CC type ___ V# ____________ Who: ______________ Member# __________