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____________________