AIB - Membership Form

	Australian Institute of Biology Inc.	Office use only	Receipt No:
	Membership Application Form		Date:

For more information on joining the AIB, see the Scope section of this site. Download a PDF copy of this form

Please fill in all sections, as appropriate.
1.	I wish to apply for election as:	(please select one)
2.	My title is:	or other: (please select one)
3.	My name is:
	Full name:
	Family name:
	Given names:
4.	My business address for correspondence is
5.	My contact numbers are (including area codes):
	Work telephone:
	Home telephone:
	Facsimile:
	E-mail:
6.	My completed academic qualifications (attach photocopy of academic record) are as follows:
	Name of first degree, diploma or certificate:
	Awarding institution:
	Major subject(s) in course:
	Year:
	Name of second degree, diploma or certificate:
	Awarding institution:
	Major subject(s) in course:
	Year:
	Name of third degree, diploma or certificate:
	Awarding institution:
	Major subject(s) in course:
	Year:
7.	I am currently studying for the following qualifications:
8.	My present appointment is:
	Title of position and grade:
	Full name and address of employer:
	The year I commenced employment in my present position was:
	Brief outline of duties and responsibilities at work or of current research work:
9.	List your previous major appointments, whether in Biology or not. Add an additional sheet if necessary. Please include dates, title of post, name of employer, concise description of work and duties.
10.	Please attach your curriculum vitæ if there is insufficient space on this form to fully list details of your employment and/or career.
11.	Where relevant, please attach a list of your publications and/or reports.
12.	The following persons have agreed to act as my referees (please give title, name, address and telephone or fax number):
	First Referee
	Second Referee
13.	I enclose payment for one year's membership at the grade of:	(please select one) prices are include GST.
	Payment Options
	Payment via (please select one):	For cheques and money orders, please make them payable to: ‘Australian Institute of Biology Inc.’
	If paying by credit card
	Card Number:
	Expiry Date:
	Cardholder Name:
	Please print out and sign
	Signed:
	Date:
14.	If elected to Membership of the Australian Institute of Biology Inc., I will agree to comply with the code of professional conduct as set out in clause 20 (1) of the Constitution which is reproduced in the information brochure.	Signed: Date:
15.	Check list: signed completed application form photocopies of all your degrees, diplomas and certificates any additional documentation cheque or money order or credit card details with signature.
16.	Let us know how you found out about the AIB:
17.	Please post to: The Registrar, Australian Institute of Biology PO Box 3108 Eltham VIC 3095 Australia

Australian Institute of Biology Inc.

Membership Application Form