Please fill in the form below and send it with your remittance by
fax or airmail to
Dr John D. Steele (Treasurer ASGRG),
School of Mathematics and Statistics,
University of New South Wales,
SYDNEY NSW 2052,
Australia. Fax: ((+61)) (2) 9385 7123
Receipts will be issued. Our financial year runs from 1 July to 30 June of
the following year. Members are encouraged to pay for multiple years.
Please fill in the years applicable in the space indicated.
Members of the Australian Institute of Physics are entitled to a 10% discount
on all memberships.
Payment by direct transfer is our preferred option.
Note: Any member in arrears must pay all arrears
since the date of first joining the Society or alternatively take out
Life Membership.
CLICK HERE TO CHECK YOUR MEMBERSHIP DETAILS.
| Name |
________________________________________________________ |
Title | ______
|
| Postal Address: |
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________Phone:__________________________
|
| Email: |
_____________________________________________________________________
|
| ___ |
I wish to pay my annual subscription of A$40 per year for
| 1 July
| ______ | - 30 June | ______ | (i.e., | ___ |
years) |
|
| ___ |
I wish to pay my annual subscription of A$20 per year (reduced rate) for
| 1 July
| ______ | - 30 June | ______ | (i.e., | ___ |
years) |
I am [circle one] ( Retired / Unwaged / a Student at
_______________________________________________________________________).
|
| ___ | a lifetime membership of A$250 (reduced to A$125 for those over 65). |
| ___ |
Please email me ASGRG account details so I can make a direct transfer of A$ _______ |
or
| ___ |
Please find enclosed a ( cheque / money order ) for A$ _______
made payable in Australian dollars to the Australasian Society
for General Relativity and Gravitation. |
or
| ___ |
Please debit my [circle one] ( Mastercard / Visa ) card by
A$ _____________ |
-
Card Number:
| ___ | ___ | ___ | ___ | ___ | ___ | ___ | ___ | ___ | ___ | ___ | ___ | ___ | ___ | ___ | ___ |
Expiry date: Card holder's name: _____________________
Card holder's phone: _______________
Card holder's signature:_____________________________________________________
Date: _______________