ABN 47 613 685 234 /

POST-GRADUATE STUDENT MEMBERSHIP

1BAPPLICATION FORM

Please sendcompleted form to:

2BICOM Australia

PO Box 266
CIVIC SQUARE ACT 2608
e-mail:
or
Louise Douglas (Membership Secretary)
e-mail:
Last name: / Given names:
Title:Mr Mrs Ms Prof Dr
Have you applied previously for membership of ICOM?YesNo
Previous ICOM membership number: / Date of birth:
(dd/mmm/yyyy)
Post graduate studentmembership: / Post-graduate student (non-voting)AUD $ 62
Please note: / Do not organise any payment at this stage. Your application will be assessed and you will be contacted about the next steps.
Postgraduate course of study: / Expected year of completion:
Your institution’s name:
Institution’s web address:
Private postal address:
Suburb: / State: / Post code:
Private tel:
(please include area code) / Private fax:
(please include area code)
Private mobile: / Private e-mail:
Supporting material: / Newpostgraduate student applicantsand renewing postgraduate student members must enclose evidence of their educational institutional affiliation and course details. For example: current Record of Enrolment or letter from the institution’smuseum related school/department. A student ID card IS NOT acceptable.
Type of material enclosed:

Language for international correspondence:(mark one only)EnglishFrench 

Language for international publications:(mark one only)English French Spanish 


If you wish to become a member of an International Committee with full voting rights, please choose one:

Architecture and Museum Techniques (ICAMT) / Museum Management (INTERCOM)
Audiovisual and new technologies of image and sound (AVICOM) / Museum Security (ICMS)
Collecting (COMCOL) / Museums and Collections of Archaeology and History (ICMAH)
Collections and Activities of Museums of Cities (CAMOC) / Museums and Collections of Arms and Military History (ICOMAM)
Conservation (ICOM-CC) / Museums and Collections of Costume (COSTUME)
Documentation (CIDOC) / Museums and Collections of Decorative Arts and Design (ICDAD)
Education and Cultural Action (CECA) / Museums and Collections of Ethnography (ICME)
Egyptology (CIPEG) / Museums and Collections of Fine Arts (ICFA)
Exhibitions and Exchange (ICEE) / Museums and Collections of Glass (GLASS)
Historic House Museums (DEMHIST) / Museums and Collections of Instruments and Music (CIMCIM)
Literary Museums (ICLM) / Museums and Collections of Natural History (NATHIST)
Marketing and Public Relations (MPR) / Museums and Collections of Science and Technology (CIMUSET)
Memorial Museums in Remembrance of the Victims of Public Crimes (ICMEMO) / Regional Museums (ICR)
Money and Banking Museums (ICOMON) / Training of Personnel (ICTOP)
Museology (ICOFOM) / University Museums and Collections (UMAC)
Do you wish to receive e-bulletins from ICOM Australia? / YesNo

Membership period

Membership is annual from 1 January – 31 December.

Invoicing

New members will be invoiced for their membership subscription after they have been approved as qualified for ICOM membership by the National Committee. Please do not send payment until advised of admission and you are invoiced.

Privacy

ICOM Australia sets out in its Privacy Statement how it collects, uses and discloses members' personal information. This statement is framed by the Privacy Act 1988(Cth)and as amended. The Privacy Statement can be found at:

Information you provide on this form will be transmitted to third parties: ICOM headquarters and ICOM’s International Committees. You have the right to access and to modify your information. The French law on Informatics & Civil Liberties (Jan. 6, 1978, rev.) provides for the equivalent right.

Authorisations

I authorise ICOM including ICOM Australia to publish my information on their websites (access to this information is restricted to ICOM Australia officers, ICOM Paris officers, ICOM committees, ICOM affiliated organisations & member services providers) / private information 
educational information 
I authorise ICOM including ICOM Australia to transmit my information to non-ICOM third parties (such as conference organisers, Museums Australia, printers, mail distributors etc) / private information 
educational information 
Declaration
I, U______U, declare that I am eligible for postgraduate student membership of the International Council of Museums (ICOM) and wish to become a postgraduate student member of ICOM. I also hereby declare that I formally accept and respect the ICOM Code of Ethics for Museums ( I am not engaged in dealing (i.e. buying and selling for profit) cultural goods including works of art or natural and scientific specimens.
Date: / Signature:

Version 2.1, 2017