Membership Application Form

Name
*
Business Name
Business Address
State
Postcode
Home Address
State
Postcode
Telephone (B/H)
Tel A/H
Facsimile
Mobile
Email
*
Mailing Address
Other Address
State
Postcode
Occupation
Experience
Interests
Sponsor
Sponsor Requ'd
Please tick if you require a sponsor
Statement
Submitting this web form signifies that I wish to apply for membership of the International Plant Propagators’ Society Ltd, Australian Region and request you to enter my name on the register. I agree to be bound by the Society’s Memorandum and Articles of Association and the Rules and By-Laws made there under. I declare that I am eligible for membership.
Options

Payment
Payment may be made by direct deposit, cheque or credit card. Cheques are to be made payable to International Plant Propagators’ Society Ltd, Australian Region
EFTPOS – Bendigo Bank BSB: 633-000
    Account #: 140 185 737
    Account Name: Aust. Region of IPPS
The secretary will contact you to get credit card details.
Return
This application will be sent to:
    Ms Pam Berryman, Secretariat
    IPPS Ltd Australian Region
    27 Petunia Crescent, Mt Cotton Q 4165
    Fax: 07 38299767
    Email: pam@ipps.org.au
 
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