MEMBERSHIP APPLICATION FORM

THE INVENTORS ASSOCIATION OF AUSTRALIA (VICTORIA) INCORPORATED

To: Hon Treasurer
30 Reids Lane
Warranwood
Victoria 3134
Australia

• I wish to become a new member ›
• renew my membership ›

I agree to be bound by the articles of the association.

Title/First Name:_________________________________

Surname:______________________________________

Address:_______________________________________

State___________________Postcode_______________

Phone:______________________________

Occupation:____________________________________

Email_________________________________________

MEMBERSHIP FEES

› Joining Subscription plus First Years Membership $200
› Renewal Subscription $80
› Corporate Subscription $350

I enclose my Cheque No___________ for $__________

Signature:_________________________

Date:_____________________________

Please provide an engraved name tag with the following title printed