Application for membership of ACMA
Australian Radiocommunications Study Groups (ARSGs)
Please fill in a separate form for each group.Completed forms must besigned by thechair of the group, and forwarded by email to the ACMA’sInternationalRadiocommunications Section - email: .
ACMA form – R201October 2014
Iapply for membership of
(full name)
(name of ARSG or preparatory group)
My involvement in this ARSG is based on: (please detail your interests and/or expertise).
I will be representing:
Note: A member who acts on behalf of a third-party client(s) must be registered on the Australian Government Register of Lobbyists and must comply with the requirements of the Lobbying Code of Conduct.
Signature of applicant Date
Note:Applicants are required to comply with the conditions of the ACMA Guidelines for participation in international and regional radiocommunications forums and meetings
Signature of ChairDate
Contact details
ACMA form – R01Page 1 of 1March 2008
Title:Surname:
Given name:
Job title:
Organisation:
Postal address:
Phone: ( )
Mobile:
Email:
ITU Telecommunication Information Exchange Service (TIES)
Do you have a current TIES account?Yes No
If not, do you require one? Yes No
ACMA form – R01Page 1 of 3March 2008
Note:ThePrivacy Act 1988 (Cth) (the Privacy Act) imposes obligations on the ACMA in relation to the collection, security, quality, access, use and disclosure of personal information. These obligations are detailed in the Australian Privacy Principles.
The ACMA may only collect personal information if it is reasonably necessary for, or directly related to, one or more of the ACMA’s functions or activities.
The purpose of the collection of the personal information in this application for membership of ACMA Australian Radiocommunications Study Groups is to facilitate the administration of the relevant study group including discussions between its members.
The ACMA will not use the information for any other purposes, nor will we disclose it, unless we have your consent or are otherwise permitted to do so under the Privacy Act.
If you do not provide the information requested your application for study group membership will be rejected.
Further information on the Privacy Act and the ACMA’s Privacy Policy is available at . The Privacy Policy contains details about how you may access personal information about you that is held by the ACMA, and seek the correction of such information. It also explains how you may complain about a breach of the Privacy Act and how we will deal with such a complaint.
Should you have any questions in this regard please contact the ACMA’s privacy contact officer by telephone on 1800 226 667 or by email at .