(ABN No. 86 771 029 027)

2004 Membership Application

Name: ________________________________________________

Job title: ________________________________________________

Institution: ________________________________________________

Campus: ________________________________________________

Postal address: ________________________________________________

Suburb: ________________________________________________

State: ________________________________________________

Postcode: ________________________________________________

Phone: ________________________________________________

Fax: ________________________________________________

Email address: ________________________________________________

Website: ________________________________________________

Membership cost

Membership is set at $20 per person per annum. Membership entitles members to all the benefits of the Association including the right to a single vote at all SHOAA meetings. Please complete a separate membership form for each person within your Institution who wishes to join SHOAA. SHOAA typically meets six times per year from April through November.

Are you a new or renewing member? New/Renewing Please circle

Would you like to receive minutes of meetings Yes/No Please circle

I wish to apply for membership of SHOAA. I agree to comply with the Constitution and Statement of Purposes of SHOAA. Please find enclosed a cheque/money order for $_____ as membership payment.

Signed: ____________________________________________ Date: ___________________

Please make cheques payable to SHOAA and send to:

Attention: Robin Turner

Membership Secretary

SHOAA

PO Box 314

Carlton South. Vic. 3053.