Australasian Sleep Technologists Association Inc.
Individual Membership Application
Please send signed membership form and copy of CV to:
ASTA secretariat c/o Festival City Conventions
Postal Address:PO Box 949, KENT TOWN SA Australia5071
Ph: +61 8 8363 1307 Fax: +61 8 8363 1604
July 2010 - June 2011
Type of Membership* Ordinary Sustaining (see last page for details)
Member’s Database Please tick box if you donot want employment details placed on member’s only section of website
Applicant details:
Title: FirstName: MI: Surname:
Current employment details:
Position: Date commenced (MM/YY):
Organisation:
Full time / Part time(If part-time, hours worked per fortnight)
Work Address:
Suburb/Town State: Post Code:
Country: Ph: () Fax: ()
Mobile: E-mail:
Contact details(if different from above):
Address:
Suburb/Town: State: Post Code:
Country: Ph: () Fax: ()
Mobile: E-mail:
Highest qualification (also attach a copy of your current CV):
Qualification (Eg. BApplSc, Grad Dip.Edu):
Year obtained:
Institution (in full):
Do you have current RPSGT qualifications? Yes No If so, BRPT number:
Applicant declaration:
By signing below (or typing my name in and sending this document back via email)I hereby certify thatI have read the constitution on the ASTA website (URL: agree to abide by the constitution and state that the information in this application is true and correct.Ensure page1 and 2 are filled in.
Applicant Signature: Date:
Applications must be proposed and seconded by two current members of ASTA.You must send a copy of your current CV to secretariat.
Proposed by: Seconded by:
Signature:______Signature:______
[Payment Detailsmust be completed and sent with application. Membership fees for pro-rata are calculated from receipt of application form]
PAYMENT DETAILS
/ NOTES
Yearly Membership cost (increased for 2010-2011as per AGM 2009):
$ AUD 75 *pro-rata, conditions apply
CREDIT CARD DETAILS:
Type of credit card (select): VISA MASTERCARD
Credit Card Number:
Card Holder’s Name:
Expiry Date: /
Credit card purchases will be shown in statement as “Festival City Conventions” and may take several working days to be withdrawn. Members must pay in Australian dollars by credit card. Please note that international credit card transactions will be affected by the daily currency rate.
Alternatively cheques can be sent to Festival City Conventions (refer to Page 1). Please make cheques payable to ASTA. Cheques from New Zealand are required to be in Australian dollars and equivalent to $AUD75.
The Society takes no responsibility or financial liability on behalf of members for fees incurred from financial institutions. The member is responsible to check if any extra fees will be charged to them when deposits are banked in Australia.
Please allow up to 4 weeks for processing.
Membership is valid from July - June each year, regardless of when dues are paid.
*Ordinary membership: for individuals working in the field of sleep medicine or sleep research.
Sustaining Membership: for company or business or their representative who wish to support the aims and objectives of ASTA. For more information refer to Section 4 of the constitution at
- PRO-RATA TABLE:
Joining between the month of: / Ordinary / Sustaining
July to end of October / Full Membership Fee / Full Membership Fee
November to end of February / 75% of full Membership fee / 75% of full Membership fee
March to end of June / 50% of full Membership Fee / 50% of full Membership Fee
Members who were previously employed will receive a concession discount of 50% on membership fees or equivalent on pro rata rate. Members with Sustaining Membership are ineligible for concession discount. Conditions apply. Contact Treasurer for details.
Membership TypeOrdinary / 50% Discount on full membership fee or equivalent on pro rata rate
OFFICE USE ONLY:
Cheque/Reference:______Receipt:______Date entered:______
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