Membership application

Organisational Income (annual) *

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

Please nominate the type of membership that applies to your organisation: *

Ordinary Member (Voting)

Associate Member (Non-Voting)

Organisations that are Not for Profit, non-party political, and not part of the telecommunications industry are eligible for Voting membership as per ACCAN constitution. Associate / Non-voting membership is suitable for all other organisations.

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

Our organisation does not have any conflict of interest from our involvement with advocacy work undertaken by ACCAN. *

Agree

Disagree

Should our application be accepted, we hereby consent for our Organisation name to be published as a Member of ACCAN. *

Agree

Disagree

Please quote either a statement of your organisational aims and objectives or the web address of your constitution.

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 *

Position *

Organisation *

Website

Address *

Address2

City *

Postcode *

Country *

State *

Phone *

Email *

Preferred Contact Method

As Director / CEO / other authorised person, I certify that the above information is correct. I understand that this application is subject to approval by the ACCAN Board: *

Agree

Disagree

Name (if different from Delegate details above)

Position (if different from Delegate details above)

Email (if different from Delegate details above)

Spam security*

Organisational membership application

Voting Delegate details

Delegate details

Authorisation