Vicaug Membership Application Form

We’d love to have you along as a member! Please fill out this form, print it and send it along with your cheque for membership fees to

Vicaug Inc
PO Box 466
Elsternwick Vic 3185
Australia

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Vicaug Registration Number A13467, ABN 13 391 159 543 . This form becomes a Tax Invoice upon payment in full.

Member name

Company name:

Address:

Suburb

Postcode

Contact name for invoices:

Telephone (BH)

Telephone (AH)

Telephone (Mobile).

Fax number

Email address

Area(s) of interest

Other attending representatives ($50 per attendee)

Note the following scale of fees (simple huh?): $50.00 for first attending member and $50.00 for each subsequent member. These figures include 10% GST, being $45.45 subs plus $4.55 GST making a total of $50.00.

This form will become a Tax Invoice upon payment in full of the above dues.

Membership is current from AGM to AGM each year.

The VICAUG Committee has a policy of not issuing or disclosing member information to any outside parties.

In the event of my admission as a member, I agree to be bound by the rules of the Association for the time being in force, such agreement also being on behalf of the other representatives nominated above.

Signed

Date

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