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IYNC Membership Application Form

ACS Online IYNC Membership Application Form


* = required fields.

Personal details:

Please provide personal details as described.

Title*

First Name*

Last Name*

Preferred First Name*

Gender*

Date of Birth*

Residential address:

Please provide details of your current residential address as well as contact details.

Address*

Suburb/Town/City>*

Postal Code*

State*

Country*

Please provide a valid phone contact number and verified email address.

Phone

Mobile

Fax

Email Address*

Verify Email Address*

Alternate Email Address

Verify Alternate Email Address

Payment:

Please provide credit card payment details.

All applications with confirmed credit card payments are fully automated. Your application will be processed, graded and your membership confirmed within the hour.

Monthly/Quarterly payments are only accepted as automatic deductions from a credit card.

Credit Card Type*

Credit Card Number*

Card Expiry*

Name on Card*

CSC/CVV/CID*

By submitting this application you are authorising the ACS to immediately deduct the stated fees from your credit card.

Future renewals:

Should future renewals be automatically deducted from your credit card?

Privacy:

Some member benefits & services are provided by contracted third parties. Applicants not wishing to receive communications from these ACS contracted service providers should indicate by ticking below:

I do not wish to receive additional valuable information from contracted third parties

The ACS lists the name and grade of new members in ACS publications. Applicants not wishing to have their personal details published should indicate by ticking the box below:

I do not wish to have my personal details listed in ACS publications

The ACS from time to time sends messages to its members which could be construed under the SPAM Act to be Commercial Electronic Messages. Typically, these messages would be promoting professional development events which in some instances attract a fee. Applicants not wishing to receive such messages should indicate this by ticking the box below:

I do not wish to receive Commercial Electronic Messages

By submitting this application you declare that all information you have provided is true and correct, and if admitted to the Society, you undertake to be bound by the Rules, Regulations and Codes of the Society, as amended from time to time.

Protecting personal information is important to ACS. More.

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