IPAA:  A Network of Strength
Online Membership Application Form

To join IPAA as an individual Member, simply fill in your details below.

Your membership will commence from the day we receive your first payment.
Fees are inclusive of GST and may be tax deductible on advice from your financial advisor.

Name:


Job Title:
Agency:
Organisation:
Work Address:

Post Code:
Preferred address for correspondence:
Home  Work
Where did you hear about IPAA?

DX Number:
Telephone (W):
Mobile:
Fax:
Preferred email:
Home Address:

Post Code:

I give permission for my work details to be shared with other IPAA Members and displayed on the IPAA web site for other IPAA Members to access
I wish to join IPAA as a:
Full member ($160.00 per annum, inc. GST)
Affiliate member ($69.00 per annum, inc. GST)
    I am under 35 years of age and my date of birth is
I am a full-time student
Alumni member ($69.00 per annum, inc. GST)
I am retired from the public sector
I wish to reinstate my membership
Previous Member number:
Payment:

You can choose to pay your membership annual or quarterly.
Once-off payment (Annual Invoice)
Invoice me now & on an annual basis when my membership falls due
Invoice my organisation now & on an annual basis when my membership falls due
Ongoing payment (Direct debit on either an Annual or Quarterly basis)
I would like to pay quarterly via direct debit
I would like to pay annually via direct debit
I will download a Direct Debit Standing Credit Card Authority Form
Please send me a Direct Debit Standing Credit Card Authority Form

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