Membership application

Wage status *

Please note: Membership fees are not charged at the time of application. ACCAN will arrange invoice/payment during the Membership approval process.

Our organisation supports ACCAN's objectives and agrees to abide by the requirements for membership set down in the ACCAN constitution and policies. *

Agree

Disagree

I do not have any conflict of interests relating to my involvement with advocacy work undertaken by ACCAN. *

Agree

Disagree

I do not have any duty (written or implied) to represent interests other than those of residential/small business/not for profit organisations as consumers. *

Agree

Disagree

I undertake to notify ACCAN if my circumstances should change during the period of my membership. *

Agree

Disagree

My employment, shareholdings or associations do not give rise to a real, potential or perceived conflict of interest with ACCAN’s aims. *

Agree

Disagree

I certify that the above information is correct. I understand that this application is subject to approval by the ACCAN Board. *

Yes

You may also attach a Curriculum Vitae.

To assist in delivering membership services to you, please provide a statement noting your areas of interest in communications and ACCAN.

Title *

First Name *

Last Name *

Organisation

Address *

Address2

City *

Postcode *

Country *

State *

Phone *

Email *

Preferred Contact Method

Spam security*

Individual membership application