Asia Pacific Mediation Forum



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APPLICATION FORM FOR A NEW MEMBERSHIP OR FOR A RENEWAL

Date:

Membership Type

( Individual

( Association

Are you applying for new membership, or renewal?

( New membership

( Renewal

Your own name

Title

Family name or surname

Personal name/s

Your organisation’s name (if applicable)

Mailing address

Postcode/ZIP code Country

Email address

Fax number (if not in Australia, please prefix with country code, e.g. +61)

Key areas of mediation practice (optional)

Benefits of your APMF membership:

1. APMF members will receive regular email updates about a wide range of activities in the region.

2. APMF organisational members can register their profiles and other information for free on the Asia-Pacific Mediation E-Centre website: apmec.unisa.edu.au

3. APMF members will receive invitations to Asia-Pacific Mediation Leadership Summit meetings organised by the APMF.

|APMF membership fees for two years (in Australian dollars) |

| |Please tick one box |

|Individual members from OECD countries |$A 80  |

|Non-OECD, students and non-earning mediators |$A 44  |

|Associations with less than 250 members |$A 150  |

|Associations with more than 250 members |$A 200  |

Payment options

1. PayPal via the APMF website

Pay the APMF by PayPal (see the logo on the Home Page of the APMF website) and then send this form to the Treasurer, Tony O’Gorman (address below)

2. Money transfer

Transfer your membership fee from your bank account to this bank account:

Bank: National Australia Bank

Account name: Asia-Pacific Mediation Forum

BSB: 085 375

Account number: 169068641

Then send details of the transfer, along with this form, to the Treasurer, Tony O’Gorman (address below).

2. Cheque or money order

Cheques or money orders should be made out to ‘Asia-Pacific Mediation Forum’ and sent, with this form, to the Treasurer, Tony O’Gorman, at the address below.

Regardless of how you are paying, please post a copy of this completed form to:

APMF Membership

PO Box 1185

Toombul Qld 4012

Australia

Or send the form by email to : tonyogorman@.au

Please regard this form as a membership offer. No separate invoice will be issued. Upon payment of the appropriate amount this form will become a tax invoice. Please keep a copy of this form for taxation purposes. For any queries, please email Tony O’Gorman or dale.bagshaw@unisa.edu.au

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