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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