ORGANISATIONALMEMBERSHIP FORM

This form is for the use of organisations wishing to become anOrganisational Member of ALARA Inc

Please complete all fields

On behalf of the organisation nominated below, I wish to apply for OrganisationalMembership of ALARA

Name of Organisation
Trading Name (if applicable) / ACN / Company Reg. Number
ABN (for Australian companies)
Street Address / Town / City
Postcode/Zip: / State / Country
Postal Address(if different from Street Address) / Town / City
Postcode/Zip: / State / Country
Web Address
Authorised Representative’s Name
TitleGiven NameFamily Name
Telephone
Country CodeTelephone Number / Mobile Telephone
Country CodeMobile Number
Position Title
Email
Authorised Representative’s Areas of Interest(Please tick all relevant)
EducationCommunity / Social Justice Gender Issues
HealthIndigenous Issues Organisational Development
Description of your organisation
Please attach or email to copy of your organisation’s Mission and organisational objectives (for example, from your organisation’s Constitution)
See over for Annual Fees and Payment Methods

ORGANISATIONAL MEMBERSHIP FORM

ORGANISATION CATEGORIES & ANNUAL FEES, including GST were applicable
(Please select one type of membership)
Is your organisation a sub-group of an already registered ALARA Organisational Member? (For example, is your organisation a research centre at an already registered university, or an agency of an already registered government department?) If your organisation is a sub-group of an already registered Organisational Member, ALARA waives your organisation’s membership fee and your organisation still enjoys the benefits of being an Organisational Member of ALARA.
Name of Organisational Member of which your organisation is a part
Corporate
(Any business or organisation that employs more than 200 staff and has a demonstrated commitment to supporting the development of the AR/PAR/AL practice)
$AU 500.00 / Professional
(Any allied professional organisation that supports ALARA’s objectives, e.g. a professional association or university. Note, this excludes Affiliate Organisations)
$AU 350.00 / SME
(Any business or organisation that employs between 10 and 200 staff and has a demonstrated commitment to supporting the development of the AR/PAR/AL practice)
$AU 200.00
Sole Trader
(Any business or organisation that employs 10 or less staff and has a demonstrated commitment to supporting the development of the AR/PAR/AL practice)
$AU 145.00 / Affiliate
(Any peer professional AL and AR network or association that shares substantially similar goals and objectives in AL, AR, PM and PAR, and actively promotes AR and AL through its mission and activities. ALARA may enter into reciprocal membership arrangements with like-organisations – please contact ALARA to discuss)
$AU 145.00(non-reciprocal arrangements)
By submitting this membership form, I confirm that:
(a)I am authorised to act on behalf of the organisation that I have stated on page 1,
(b) I have read, understood and accept,on behalf of the organisation, ALARA’s Privacy Policy (), and
(c)I understand that membership must be approved by ALARA’s Management Committee before the organisation can become a member of ALARA.
We offer a range of payment options. Details can be provided on the Tax Invoice that we will send to you on receipt of your membership application / / /
Remember: If you want to join and pay online, just go to
Alternatively, please return the completed form to us:
By post to:PO Box 1748 TOOWONG
Queensland 4066 AUSTRALIA
By FAX to:+ 61 (7) 3342 1669
BY email to:

ALARA will email your invoice within 2 working days and normally process memberships 5 working days after receiving payment. You will receive an email confirming activation of your account, and details on how you can access website functions.

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