Australian Association for Professional and Applied Ethics ABN 91 541 307 476 http://aapae.org.au RENEWAL / APPLICATION FOR MEMBERSHIP – 2015(1) The completed form may be posted, emailed, or faxed. See details below. Name: ___________________________________________________________ Title: Postal address: ________________________________________________________ Postcode: Organisation: If Institutional Membership, name of contact person: Telephone: (1) ___________________________________ (2) Email address: [ ] Please include my email address on the AAPAE’s distribution list. I enclose payment of: [ ] A$60 Individual membership plus [ ] A$40 for a hardcopy of REIO Conference Proceedings volume [ ] A$20 Concession membership(2) plus [ ] A$40 for a hardcopy of REIO Conference Proceedings volume [ ] A$200 Institutional membership (includes a hardcopy of REIO Conference Proceedings volume) Please select ... / BANKCARD (tick one) for the amount of A$ [ ] Please debit my VISA / MASTERCARD Card Number: ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ Expiry date: _______ / _______ Cardholders’ name: Signature: ________________________________________________________ Date: OR [ ] Electronic funds transfer (EFT) Account name: Australian Association for Professional and Applied Ethics BSB: 063 408 Account number: 1001 8617 SWIFT code: CTBAAU2S (for international bank transfers) OR I enclose a Cheque / bank draft (in Australian dollars), payable to: Australian Association for Professional and Applied Ethics Postal address: AAPAE, C/- 37 Kitchener Street, Maroubra NSW 2035 Australia Enquiries: through post, email ([email protected]), or Tel: +612 9385 2320. Fax: +612 9385 1029 (1) (2) (3) Membership covers the period from 1 January to 31 December 2015, and includes entitlement to receive the AAPAE’s newsletter, Australian Ethics and a reduced registration rate for the Annual Conference. Postgraduate students and others entitled to concessions. As the AAPAE is not registered for GST, GST is not payable on membership fees. Australian Association for Professional and Applied Ethics ABN 91 541 307 476 http://aapae.org.au Member information: The AAPAE maintains a directory of members. The intention is that this directory will be available to members and others (upon request only) to provide networking opportunities. Please include here only such information as you wish to be made available to others in the membership directory. Name: ___________________________________________________________ Title: Position: Organisation: Qualifications: Telephone: (1) ___________________________________ (2) Email address: Areas of interest and expertise (not more than 100 words): The AAPAE is also seeking to extend the scope of its activities, within the objectives laid down in the constitution. As part of this activity, it is seeking to improve the level of contact with those outside the Association. Additional information from members about their interests and willingness to assist will help in this endeavour. The information in this box will not be made available to others, other than the AAPAE Committee, without the specific approval of the member. It will not be included in any published directory of members. [ ] I am willing to consider requests from organisations for the AAPAE to provide a speaker on topics in professional and applied ethics. If yes, in what topics: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ _______________________________________________________________________________________ The AAPAE respects and protects the privacy of its members, and is bound by the provisions of the Privacy Act 1988 (Cth), including the Australian Privacy Principles.