Western Australian Institute for Educational Research

Membership Application Form

This form is for use only by persons who are unable to register for and attend Forum 2008. If you are able to and wish to attend Forum 2008, please use Register for Forum 2008 to obtain a new or renewal membership.

Membership without Forum registration includes the journal Issues in Educational Research and regular mailing updates regarding WAIER Research Seminars. The subscription for membership without Forum registration is $70.

Please dump to printer, complete details and return with payment enclosed, to
Dr Lina Pelliccione
Department of Education
Curtin University of Technology
GPO Box U1987, Perth WA 6845
L.Pelliccione@curtin.edu.au

If electing payment by credit card, an alternative is to email details
to the WAIER Treasurer (email address given above).

I wish to join/renew my membership of WAIER for the 2008/2009 membership year.
[Membership expires July 31, 2009]


Title: _______   Name: ______________________________________________________

Status (circle one):     Full-time or Part-time Student       Full-time Academic
      Other (specify): _______________________

Phone (optional): ______________(Wk) ______________(Hm)

School/University: ______________________________________________________

Contact Address: _______________________________________________________

________________________________________________________

_____________________________________ PostCode: _________

Email Address: ________________________________________________________


Payment option (circle one):       Cheque       Credit Card

If Credit Card payment, give type (circle):       Visa       Mastercard       Bankcard

Name on Credit Card _______________________________________________

Credit Card Number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Amount to be paid (see above): $________ Expiry Date __ __ / __ __

Card Holder Signature ____________________________________________

If using a cheque, please make it payable to the 'Western Australian Institute for Educational Research' or 'WAIER'.

Enquiries: Dr Lina Pelliccione
Department of Education
Curtin University of Technology
GPO Box U1987, Perth WA 6845
L.Pelliccione@curtin.edu.au; Tel: 9266 2169

[ WAIER Home Page ]
This URL: http://www.waier.org.au/about/mem-applic-form.html
Last revised 27 May 2008.
HTML: Roger Atkinson [rjatkinson@bigpond.com]