Application for membership/course enrolment

Please fill in the application form below.

This is a 2 step process, after you submit your membership details you can follow a link to our secure payment gateway to make your payment using Visa or Mastercard.

1. APPLICATION FOR MEMBERSHIP OF PHOTOACCESS INCORPORATED

(incorporated under the Associations Incorporation Act 1991)

Name

First Name: *

Last Name: *

Address Details

Address Line 1: *

Address Line 2:

Suburb: *

State: *

Postcode: *

I apply to become a member of PhotoAccess Incorporated. In the event of my admission as a member I agree to be bound by the rules and code of conduct of the association for the time being in force.

I agree to the above statement: *

yes

2. COURSE ENROLMENT

I have read and understand the important information about courses and course enrolments at http://www.photoaccess.org.au/conditions and I would like to enrol in:

Course Details

Course Name:

Please select the course you wish to enrol in.

If other please enter details:

Date Commencing:

3. PAYMENT

Payment Details

I am paying to join PhotoAccess for one year, $55 full fee or $33 age/other concession (if enrolling in a course please ignore):

I am paying to enrol in a course (current members deduct $20 from course fees that include membership):

Total amount owing: *

Payment by: *

Follow link on next page for online credit card payments

4. CONTACT DETAILS

Additional Contact Details

Email: *

Work Phone:

Home Phone:

Mobile Phone:

Application for membership/course enrolment

1. APPLICATION FOR MEMBERSHIP OF PHOTOACCESS INCORPORATED

2. COURSE ENROLMENT

3. PAYMENT

4. CONTACT DETAILS

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