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Membership Form

Are you applying for a new membership or renewing an existing one?

I am*

Please select an option

Please select the type of membership

Membership Type*

Please select a membership type

You will be required to attach proof of Student status to be eligible for Student Associate membership.

Attach File
Invalid Input

Please attach proof you are a Student. A clear scan of a current student ID will suffice.

(Allowed File types: .zip, .pdf, .jpg, ,doc)

 
Please fill in your Name and contact details.

Name*
Please enter your name

Address*
Please enter your address

Phone
Please enter a contact phone number

Fax
Please enter a Fax number

Mobile
Please enter a mobile number

Email*
Please enter a valid email address

 

Please select relevant qualifications including date and institution gained.

You must attach a copy of qualification or educational transcript as evidence of qualified status.

The committee may waive or vary this requirement upon request (SLIANZ Constitution, clause 4.1[a])

Qualification
Please select a qualification from the list

Year gained
Please select year of qualification

Institution
Please enter the institution where qualification was gained

Attach file
Invalid Input

Qualification
Please select a qualification from the list

Year gained
Please select year of qualification

Institution
Please enter the institution where qualification was gained

Attach file
Invalid Input

Qualification
Please select a qualification from the list

Year gained
Please select year of qualification

Institution
Please enter the institution where qualification was gained

Attach file
Invalid Input

 

Agreement

As a member of SLIANZ (Inc) I will agree to adhere to the:

  1. Code of Ethics and
  2. Best Practice

*

You must agree to continue with your application.

Privacy Act (1993): Statement

SLIANZ Inc collects the above information to compile a list of SLIANZ members; this list will be held by SLIANZ committee members and the Editor of the SLIANZ newsletter.

You have the right to access and correct any information about yourself held by SLIANZ. This information will not be passed to any third parties except as required under the Privacy Act 1993.

Failure to provide the above information could result in a delay in the processing of your membership application, which may in turn lead to omission from the SLIANZ Register.

 

Thank you summaryname, you will receive an email shortly confirming your application that includes payment details for membership fees. Your application will be processed once we have received payment.

Membership type: summarymemtype
Membership fee: $summarymemfee
Joining Fee: $summaryjoinfee
Total: $summarytotal (GST Inc)

Sorry, we need to prove that you are a real human and not some nasty spam-bot

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