ACTA Membership Application Form

Table of fees: (Australian dollars) Please read "About ACTA" before filling out this form.
-Ordinary Member $38.50  ($27.50 Joining + $11 Annual Subscription)
-Associate Member $44.00 ($27.50 Joining + $16.50 Annual Subscription)
(For members from countries other than Australia or New Zealand please add $10 to the above amounts to cover the extra charges for airmail.)
Once you are a member, annual renewals are:
-Ordinary Member  $11.00
-Associate Member $16.50
(For members from countries other than Australia or New Zealand annual renewals are $15 and $20 respectively)

Please print out this membership form, fill in the relevant details and return with payment to: 

ACTA Inc.
"Comarden", Duncan's Creek
Woolomin  NSW  2340
Australia

Surname:_________________________   Forenames:________________________________
 
Organisation:________________________________________________
 
Address:___________________________________________________
 
Ctiy/Town_______________________________  Postcode:__________
 
Telephone:________________________   Facsimile:_________________________
 
Email:_____________________________________________________
 
Please place tick in the appropriate space:
Ordinary Member__     Associate Member__      
(If Ordinary Member, please enclose a letter detailing how you are chemically affected)
Do you wish secrecy?
Yes__     No__
Enclosed:
Cheque__    Money Order__
(Payable to ACTA Inc. See table of fees above)
Value $________
Who introduced you to ACTA?___________________________________
 
Signature___________________________________Date____________________
 
Office use only: A ..... or R .....
M'ship No: .....................
Processed by ......................................................
Date ........................... R/N ...........
Back to "About ACTA"