The Institute of Plumbing Australia (incorporated)
TAX INVOICE ABN 93 721 622 941
PRINT OUT THIS APPLICATION FOR MEMBERSHIP AND COMPLETE IN BLOCK LETTERS. WHEN COMPLETED FORWARD P O Box 2005 MARMION WA 6020
To the Council of the Institute of Plumbing Australia, Incorporated.
I, .....................................................................hereby apply to be *admitted/upgraded to membership of the Institute of Plumbing Australia, Incorporated and agree that on acceptance of the Grade of membership determined by the Council, I will conform to the Constitution of The Institute and as far as shall be within my power, promote and uphold its objects.
I understand that resignation can only be granted
to financial members who return their membership Certificate together with a
written request to be released from foregoing Obligations.
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DECLARATION BY APPLICANT:
I declare that the statements by me and the information attached to this application are true and I am prepared to submit proof of same on request. Enclosed is my payment of $165.00 (incl. GST of $15.00) being for 12 months subscription for corporate membership ($120.00 + GST) and entrance fee ($30.00 + GST). For Student applicants please contact the Secretary for current rates and provisions. For Companies applying for Industrial Associate membership please use separate form.
Signature:................................................................... Date: .........................................
GRADE TRANSFER (for upgrade only)
Year of admittance to Institute ............................ Present grade of membership..................
EMPLOYMENT HISTORY
Please attach details of your past 5 years employment, stating Employer, Business Activity, Your Position and Dates of Employment.
EDUCATION AND TRAINING
Please list
particulars of ALL formal education, and any MAJOR Training Courses you
have completed. Attach a separate list if insufficient room.
Please DO
NOT use initials. (Photocopies of the degrees, diplomas, certificates must
be attached. )
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Name of School, University, College of Training Institution |
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Qualifications Obtained or Examinations Passed |
Dates |
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MEMBERSHIP IN OTHER INSTITUTES OR ASSOCIATIONS
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FURTHER RELEVANT EXPERIENCE OR QUALIFICATIONS
(Include any special or unusual attainments, designs, research work, jobs handled in Industry or Authorships)
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MEMBERSHIPS AVAILABLE (To be selected by the Institute Council):
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Honorary Fellow |
Fellow |
Member |
Licentiate Member |
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Companion Member |
Associate Member |
Student |
Industrial Associate (see separate form) |