Note: Please fill and print this form for signature, then email a scanned copy of signed form to ASTS-CONTACT @ AUSINAN.ORG, or post the original to: ASTS, PO BOX 40, EPPING NSW 2121.
Contact Information:
| Title: | |
| Surname: | First Name: |
| Chinese Name: | (in any) |
| Postal Address: | |
| Phone (home): | (work): |
| Mobile: | |
| Email: | |
| Personal Website: |
Statistical Information:
| Sex: | Date of Birth: |
| Field of Study: | |
| Highest Degree: | |
| Current Employer: | |
| Current Position: | |
| Employer Website: |
I would like to publish my name, personal website, employer name and website on the member page of ASTS website.
Declaration:
I, , hereby apply to become a member of the Ausinan Science & Technology Society, and $20 ( [ ] Cash, [ ] cheque payable to Ausinan Science & Technology Society, or [ ] transfer to ASTS Account: BSB: 082 372 A/C 858886826) is included as my membership fee for the first year. I agree to be bound by the rules of the Society for the time being in force.
Signature: Date:
Nominations:
I, , a member of the Ausinan Science & Technology Society, nominate the applicant, for membership of the Society.
Signature: Date:
I, , a member of the Ausinan Science & Technology Society, second the nomination of the applicant, for membership of the Society.
Signature: Date: