Membership applications

Email *

Password*

Retype Password *

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

Ordinary Member (Voting)

Associate Member (Non-Voting)

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

Agree

Disagree

This 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.

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 below)

Position (if different from Delegate details below)

Title *

First Name *

Last Name *

Position *

Organisation *

Address *

Address2

City *

Postcode *

Country *

State *

Phone *

Price

$ AUD

Tax Amount

$ AUD

Gross Amount

$ AUD

Payment Method

Credit Card payment through Bendigo Bank via eWay

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Holder Name*

Organisational membership

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Membership Information

Voting Delegate details

Secure Payment Information