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Home Join ACAud Join Now - Fellow or Ordinary
Fellow or Ordinary Application
Please download and read the full application form before proceeding.
This is a tax invoice when accompanied by payment.
Fellow or Ordinary *
Surname *
First name *
Title
Preferred Name
.
Company name
Company Street
Company Suburb
Company Postcode
Company Country
.
Your home Street
City
State
Post code
Country
Home phone
Work phone
Work fax
Mobile
Email *
.
Send mail to
.
Tertiary Qualifications:-
Please list all relevant qualifications in the space below.
Certified Copies of degrees, diplomas, certificates, and OHS advice of practitioner number
are to be emailed with this application
Relevant qualifications
.
Employment Summary:-
Please state date, month & year employment commenced, and duties performed.
Employment details are required for the previous four (4) years:
Date of employment, Name of Employer, Duties & Position, Full-Time/Part-time.
Employment Summary Form
.
TOTAL:
$ *
I would like to pay by:
Pay by type
Credit Card facilities are available for your convenience.
Please fill in the information below if you wish to use the credit card facility to pay your membership fees.
Please note: a surcharge of 2% will apply to all credit card transactions.
Card Name
Card number
Expiry date
Amount $