Nutrition Australia
GENERAL MEMBERSHIP
APPLICATION
FORM
Title: Mr/ Mrs/ Miss/ Ms
Given Name:_______________________________________
Family Name:______________________________________
Postal Address:_____________________________________
_________________________________________________
_________________________________________________
________________________________ Postcode: ________
Telephone: (BH) _______________ (AH) ________________
Email: _________________________________________________
Occupation:
_________________________________________________
Work location:
_________________________________________________
I / We agree to support the Rules of Association and
the general objectives of Nutrition Australia which are:
- to be an independent and authoritative body that
aims to promote the health and well-being of the Australian people by
encouraging them to make informed food choices;
- to base all activities on scientific principles
and knowledge related to human nutrition and dietetics and food
science and technology.
Signed: _________________________ Dated:
____________
Annual Membership Fees
Yes! I would like to join as a member. I have
indicated my membership type below:
|
P |
Membership Type |
Membership Fee |
| |
Full Membership |
$60.50*
(includes GST) |
| |
Overseas
Membership |
$60.50*
(no GST) |
| |
Full Time
Students and Pensioners
(Please circle Student or Pensioner) |
$38.50*
(includes GST) |
Membership expires 31st December of each year
Please print this form and attach a cheque/ money
order made payable to Nutrition Australia or complete the credit card details below
and send to:
Nutrition Australia
6/100 Campbell St
Bowen Hills 4006
Australia
Fax: (07) 3257 4616
ABN 58 909 342 093
A tax invoice will be issued upon payment
Credit Card Details
Please debit my (please circle) Bankcard
MasterCard
Visa
Cardholder’s Name:
_______________________________________________
Card Number:
Expiry date: __________Signed:_________________________ |