ACS APPLICATION FOR PERSONAL MEMBERSHIP
 
You will initially be awarded the grade of affiliate. This category of
membership is open to anyone who wishes to further the objects of the
society. Affiliate members receive all membership benefits except for the
use of the letters MACS or MACS after their name. Professional grades are
Member (MACS), Associate (AACS), Provisional Associate (AACS (PROV)).
These grades are awarded to applicants who meet the relevant experience
and/or qualification criteria.
 
Australian residents should complete the form below. Others should contact
the ACS National Office (telephone +61 2 2115855, Internet:
peterh@acs.org.au). Separate forms are available for student membership
and reclassification.
 
� �  Tick here if you wish to receive regrade details for professional
     membership.
 
 
Family Name              _________________________________
 
Title                    _______________________
 
Given Names              _________________________________
 
Date of Birth            ____/____/19____     Male � � or Female � �
                         DD   MM    YY
 
Address for Mailing      � � Business        � � Home
 
__________________________________________________________
 
__________________________________________________________
 
__________________________________________________________
 
State          __________________    Postcode       __________________
 
Home Phone     __________________    Home Fax       __________________
 
E-mail         __________________
 
Your Current Position    __________________________________
 
Employer's Name          ____________________________________________
 
State          __________________    Postcode       __________________
 
Business Phone __________________    Business Fax   __________________
 
E-mail         __________________
 
 
If previously a member of the ACS, please give Branch, grade and year.
 
Branch         _________________________________
 
Grade          _________________________________
 
Year           __________________    Membership No. __________________
 
If a member of another computer society, please provide details of grade
and financial status.
 
 
METHOD OF PAYMENT
 
My application fee of $AU ____________ is enclosed.
 
� � Please tick for receipt
 
I wish to pay by � � cheque and my cheque is enclosed OR � � credit card,
details below.
 
Cardholder's name _________________________________
 
� � Bankcard   � � Mastercard   � � Visacard
 
Card Number    ________ ________ ________ ________
 
Expiry Date    __________________
 
Cardholder's signature _________________________________
 
 
If admitted to the Society, I undertake to be bound by the constitution
and the by-laws of both the Society and the Branch in which I am enrolled,
as amended from time to time.
 
 
Signature of Applicant _________________________________
 
Date      __________________                                (tw-Internet)
 
 
 
1993 BRANCH FEES
 
Please tick the branch you wish to join
 
     Branch    Fee
 
� �  Canberra  $AU74
� �  N.S.W.    $AU93
� �  N.T.      $AU71
� �  QLD       $AU83
� �  S.A.      $AU83
� �  TAS       $AU76
� �  VIC       $AU93
� �  WA       $AU103
� �  Overseas  Contact the national office for details.
 
APPLICATION TO BE SENT TO
 
All states other the Queensland:
 
A.C.S.
PO Box 319
Darlinghurst NSW 2010
fax: +61 2 2811208
 
Queensland:
 
ACS
PO Box 135
Aspley Qld 4034