Australia New Zealand Marine Biotechnology Society Inc.

for the advancement of marine biotechnology

Membership application

Please double-click check boxes to select options if filling in this form electronically.

Title:
First Name: / Middle Initial:
Last Name:
Institution / business name:
Institution / business address:
(Check this box to useyour institutionas your mailing address)
Residential Address (optional):
Australia New Zealand Other Country Please state:
(Check this box to use this as your mailing address)
Email:
Research areas of interests:
Phone: (Please include country and area codes)
Mobile phone: (Please include country code eg. +61)
Annual Subscription Rates (until – 30/6/16)
Membership Type / Subscription[i] / Check
Professional (current or retired) / $ 30
Student / $ 20
Corporate(up to 6 named members)* / $ 150
* The person named on this sheet will be the main corporate contact. Please provide names and email addresses of additional members on a separate sheet. If more than 6 people add $25/person.
Associate (non-voting) / $ 35

RULES: By becoming a member of the Society you agree to abide by the rules. A copy can be found at

DONATION/SPONSORSHIP: Please contact the treasurer if you would like to provide a further donation to the .

Corporate Membership additional members(attachextra lines for additional members)

Title / First name / Second name / Email address / Student?
2 / Select /
3 / Select /
4 / Select /
5 / Select /
6 / Select /

(If students are included in corporate membership the rate is the same as Professionals)

Payment Method[ii], [iii]
EITHER Electronic Funds Transfer (EFT) payments should be made to:
If you live in Australia
Account Name: Australia-New Zealand Marine
BSB:805-050 (People’s Choice CU)Account No: 100175050
If you live in New Zealand
Account Name: ANZMBS
Account Number: 06-0433-0525275-00 (ANZ bank)
To assist with identifying your EFT payment, please use your name as the message when entering the transfer information.
If you have the facility, please use the ‘email this transaction’ option to
OR Cheque or Money Order should be made payable to the Australia New Zealand Marine Biotechnology Society (ANZMBS).Please cross the cheque and write your details on the back.
Postal address:
In AustraliaTreasurer, Australia New Zealand Marine Biotechnology Society, c/o Centre for Marine Bioproducts Development. HLTH 4.17Dept. of Medical Biotechnology, Flinders University; GPO Box 2100, Adelaide, South Australia, Australia 5001
In New ZealandMs Te Puea Dempsey, Gate 1, Knighton Road, Private Bag 3105, Hamilton, New Zealand
If your institute is paying for your membership
My institute requires an invoice
To be sent to:
Name
Address

Please forward completed form to

ANZMBS Membership Application / 1
Please note this is a MS Word Macro (.docm) enabled form. Correct as of 31 March 2015.

[i] Correct as of 31/3/2015. All values are in Australian or New Zealand Dollars. Does not include any GST.

[ii]Any additional banking transaction fees should be paid for by the payee / sender.

[iii]Membership will commence on successful receipt of annual subscription funds and processing of application form.