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 2011. If you are able to and wish to attend Forum 2011, please use Register for Forum 2011 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 $50.

Please dump to printer, complete details and return with payment enclosed, to
Mr Brad Gobby
School of Education
Rockingham Campus, Murdoch University
Dixon Road
Rockingham WA 6168
Email: b.gobby@murdoch.edu.au

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

I wish to join/renew my membership of WAIER for the 2011/2012 membership year.
[Membership expires 31 July 2012]


Title: _______   Name: ______________________________________________________

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

                          Other (specify): _______________________

Phone (optional): ______________(Wk)       Position: ______________

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: Mr Brad Gobby, WAIER Treasurer
School of Education
Rockingham Campus, Murdoch University
Dixon Road
Rockingham WA 6168
Email: b.gobby@murdoch.edu.au Tel: 9360 7124

[ WAIER Home Page ]
This URL: http://www.waier.org.au/about/mem-applic-form.html
Last revised 7 Apr 2011.
HTML: Roger Atkinson [rjatkinson@bigpond.com]