Group membership application

This application is:*
- for a group, organisation, department, etc.
- to renew membership (group)
Group/organisation membership – application/renewal*
- not-for-profit — $500
- for-profit — $1,500
This selection means that you – are a applying on behalf of a not-for-profit group, organisation, unit, department, etc. – seek to hold education events, seminars, classes, professional development courses, research meetings, etc. at Graduate House – want your events to be at a not-for-profit price, hassle free, and with good service, food, AV and hygiene
This selection means that you – are a applying on behalf of a for-profit group, organisation, unit, department, etc. – seek to hold education events, seminars, classes, professional development courses, research meetings, etc. at Graduate House – want your events to be in a university setting, hassle free, and with good service, food, AV and hygiene

APPLICANT INFORMATION
Your name*
Title First Middle Last Post-nominals
Position in organisation*
Please specify – for example, professor, researcher, lecturer, board member, CEO, staff member, events coordinator, etc.
Other*
Please specify
Name of group, organisation, department, institute, etc.*
Australian Business Number (ABN)
If the organisation/group is not incorporated, please leave this field blank.
Logo of organisation
Name the file to identify the organisation and upload type: Organisation name_Logo. The file should be less than 3MB. Once uploaded, the words ‘No file selected’ are replaced by the file name. Though this is a non-required field, there is benefit from visibility in the Association’s media.
Accepted file types: jpg, png, pdf, eps, Max. file size: 3 MB.
Your phone number: landline or mobile*
Your email address:*
The tax invoice will be sent as an attachment to this email.
Enter Email Confirm Email
Postal address of group, organisation, department, institute*
Enter the postal address of the group, organisation, department, institute, etc. This is required for tax invoice purposes.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Details
Name*
Prefix First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mobile Number / Telephone Number*
Email
I wish to be named as a donor*
- Yes
- No
^ Yes' indicates that you are happy to be acknowledged (first name and surname) for your donation in our publications. 'No' indicates that you wish to remain anonymous. If neither 'Yes' nor 'No' is selected a 'Yes' response is assumed.

Payment
Total
$ 0.00
Method of Payment*
- Debit/Credit Card
- Cheque
- Bank Transfer
- Direct Debit
Bank Transfer Details
Account Name: Diamond Jubilee Campaign
Bank: ING Bank (Australia) Limited
BSB: 923 100
Account Number: 6079 1331
Swift Code: INGBAU2S
Description: Surname_Firstname_2018
- Directed to The Graduate Union of The University of Melbourne Inc.
Credit Card*
Card Details
Cardholder Name
Financial Institution*
BSB*
Account Number*
Frequency**
- Weekly
- Fortnightly
- Monthly
- Yearly
Commencing:*
DD slash MM slash YYYY
I would like to give regularly through my selected payment option*
I agree to the Automatic Payment Service Agreement
Automatic Payment Service Agreement
Signature*
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

APPLICANT INFORMATION