Institutional Membership Application/Renewal Form

INSTITUTIONAL MEMBERSHIP APPLICATION/RENEWAL FORM

You are invited to renew or apply forInstitutional Membership of Educate Plus for an annual fee of $990 (excl GST).

InstitutionalMembership provides you with 3 full memberships and an unlimited number of Associate Memberships.

Full benefits may be gained for the additional Members by payment of $100 (excl GST) per person. This fee will allow the full range of member benefits and can only be taken up as an add-on to Institutional Membership.

Items not included in Associate membership:

• Access to Scholarships
• Access to Educate Plus Special Awards (Trevor Wigney etc)
• Use of post nominal M.Edplus & F.EdPlus – unless individual membership or add on membership is taken out – or they already hold a Fellowship.
• Membership years criteria as part of the Fellow nomination unless individual membership/add-on membership is taken out.
• Voting Rights
• Ability to serve on a Chapter Committee

DETAILS

Institution Name
Institution Address: Street:
City: / Postcode:

Details of 3 full membership nominees ($990 excl GST)

An appointed representative should complete this form on behalf of their Institution.

1. Name: / Title / First Name / Surname
Position/Work title:
Email Address
Direct Line:
Mobile:
2. Name: / Title / First Name / Surname
Position/Work title:
Email Address
Direct Line:
Mobile:
3. Name: / Title / First Name / Surname
Position/Work title:
Email Address
Direct Line:
Mobile:

ADDITIONAL MEMBERS

Please add the names and details of all your additional members.

4. Name: / Title / First Name / Surname
Position/Work title:
Email Address
Direct Line:
Mobile:
Category(Select one) / Additional Full Member ($100) / Associate Member
5. Name: / Title / First Name / Surname
Position/Work title:
Email Address
Direct Line:
Mobile:
Category(Select one) / Additional Full Member ($100) / Associate Member
6. Name: / Title / First Name / Surname
Position/Work title:
Email Address
Direct Line:
Mobile:
Category(Select one) / Additional Full Member ($100) / Associate Member
7. Name: / Title / First Name / Surname
Position/Work title:
Email Address
Direct Line:
Mobile:
Category(Select one) / Additional Full Member ($100) / Associate Member
8. Name: / Title / First Name / Surname
Position/Work title:
Email Address
Direct Line:
Mobile:
Category(Select one) / Additional Full Member ($100) / Associate Member
9. Name: / Title / First Name / Surname
Position/Work title:
Email Address
Direct Line:
Mobile:
Category(Select one) / Additional Full Member ($100) / Associate Member

(add more if required)

Please save and send this form to

Based on the information provided above, your institution membership fee will be calculated and an invoice will be drawn up and emailed to you.

To whom should this invoice be sent?

Name:
Position: / Email address:

Notes:

1)Members are not required to take out Institutional membership.(although this is encouraged) Individual membership options remain.

2)Where members’ renewal dates differ, a pro rata calculation may be made to align them all.
(Contact Operations Manager:)

3)Associate Members can attend all Educate Plus events at ‘Member’ rates.

4)Fellowship discount does not apply to Institutional member rates.

Benefit Summary / Full / Associate
Use of the M.Edplus post-nominal / Yes / No
Scholarships / Yes / No
Access to Training and Professional Development / Yes / Yes
Member rates for conferences / Yes / Yes
Access to Excellence Award Program / Yes / No
Potential for Fellowship / Yes / No
Voting Rights / Yes / No
Committee Representation / Yes / No
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