Please fax this back to: 02 9299 3997 (no cover sheet needed) or mail to:
| Title (Ms, Mr, Dr, Miss etc) | ACS Membership Number |
| ______________________________________ | ______________________________________ |
| Address for mailing | Tel:_____________________________ |
| ______________________________________ | Fax:________________________________ |
| ______________________________________ | Email __________________________ |
| ______________________________________ | ______________________________________ |
I, ________________________________, solemnly declare that I have completed 30 or more hours of professional development activities in the previous twelve months, in accordance with the ACS Practising Computer Professional (PCP) guidelines.
Signed:______________________________________ Dated: ________________________
Tick here if you would like a PCP certificate. [___]