INTERNET SOCIETY OF AUSTRALIA             Tax Invoice  ABN 36 076 406 801 

This form should be printed out and faxed or posted to us.  Do NOT email.
FAX form and card details to: (02) 9652 2145
or POST form and cheque to:   The Treasurer, ISOC-AU
                              PO Box 351, Glenorie NSW 2157

PLEASE TICK either  [ ] NEW membership  OR  [ ] RENEW existing membership   

Title:_______ First name:__________________ Last name:_________________________

Postal Address:________________________________________________________________

State:_____________  Postcode:_______________  Country: _______________________

Phone (BH):____________________________  Phone (AH):___________________________

Occupation or Organisation:____________________________________________________

Email address:_________________________________________________________________

If renewing and your email address has changed since last year, please enter 
your OLD address: _____________________________________________________________

All members automatically join the email list iamems-announce, as it is the
official means of legal notifications. The separate members' discussion list,
iamems, is an important channel for members' interests, but if you do NOT wish
to join iamems, please tick here:  [ ]

ISOC-AU is a Chapter of the worldwide Internet Society (ISOC, www.isoc.org).
Anyone who becomes a member of ISOC-AU automatically becomes a global member of
ISOC, and their name, address and email address are sent to ISOC. If you do NOT
want to have your details forwarded to ISOC, please tick here:  [ ]

See http://www.isoc-au.org.au/Membership/ for member benefits.

Fees per year in Australian dollars, including GST: 
  Individual membership:                  Organisational membership:
  [ ] $90.00 Full                        [ ] $275 Foundation
  [ ] $35.00 Concession                  [ ]$1100 Enterprise
                                         [ ]$2750 Strategic

EXISTING Member UPGRADING to below - 20% off for first year of upgrade:
                                         [ ] $220 Foundation
                                         [ ] $880 Enterprise
                                         [ ]$2200 Strategic

Member living outside Australia (GST not due):  
  [ ] $81.82 Full                        [ ] $250 Foundation
  [ ] $31.82 Concession                  [ ]$1000 Enterprise
                                         [ ]$2500 Strategic

If Concession, enter Pension/Concession no:____________________________________
or
Student no:___________________ Institution:____________________________________

Payment by: [ ]Cheque         [ ]Mastercard       [ ]Visa  

Card Number:___________________________________________________________________

Expiry Date:____________________  Name on Card:________________________________

Credit card to be debited 1 July annually until further notice: [ ] Yes  [ ] No


Declaration: "I wish to be accepted as a member of the Internet Society of 
Australia. I declare that I have read, understood, and will abide by the 
Constitution of the Society (see http://www.isoc-au.org.au/).  As a member 
I undertake to support Internet development for the benefit of all of its 
users.  I confirm that all of the information I have submitted is correct."

Signed: __________________________________________ Date________________________