CIPS Australasia
Membership Application
The Chartered Institute of Purchasing and Supply Australasia (CIPSA)
Membership Benefits
______
CIPS Australasia Application for Membership ABN: 32 111 330 262 Page 1 / 5
Application for Membership
1.Personalinformation
Male Female Mr Mrs Miss Ms Other
First names: Family name: Date of birth:
2.Home contact details
Address:Suburb:
State:Postcode: Country:
Home Tel:()Home fax:() Mobile:
Personal email:
3.Work contact details
Do you work for a public or a private sector organisation? Public sector Private sector
Organisation Name:
Organisation Address:Suburb:
State:Postcode: Country:
Direct line : ( ) Work fax: ()
Work Mobile:Switchboard Tel: ()
Work email:
4.Previous membership of CIPS
Membership number: Grade held:
5.Employment details
Nature of Employment: Self Employed Consultant Procurement Profession
Your job title:Dept/Section:
Date started present job:Years in Procurement:
Job Rank
______
CIPS Australasia Application for Membership ABN: 32 111 330 262 Page 1 / 5
Chief Exec/MD
Analyst
Manager
Asst. Manager/Supervisor
Director/Dept / Senior Manager
Retired
Operative
Trainee Graduate
Unemployed
______
CIPS Australasia Application for Membership ABN: 32 111 330 262 Page 1 / 5
Job Grade:To whom do you report? (Jobtitle):
Salary bands (AUD)
<25K 26-44K 45-65K 66-85K 86-105K 106-140K 141- 160K 161K+
Personal spend/Budget-annual value of purchases/contracts (AUD)
<250K 250K-1M 1-5M 5-10M 10-50M 50-100M 100-500M 500M+
Your role/influence within your organisation (Select one only)
Strategic Operational Administrative Junior
Number of full-time procurement staff in organisation: <5 6-10 11-20 21+
Number of staff managed by you:
Professional Interests – Please choose 5 only
______
CIPS Australasia Application for Membership ABN: 32 111 330 262 Page 1 / 5
Benchmarking
Buying Services
Buying Travel
Contract Drafting
Contract Management E-business
Energy
Environment Ethics/CSR
Education
Facilities Management Financial Regulations
Freight/Transport
Global Purchasing Government Initiatives IT/Software Procurement Legal Issues Negotiation
Operations Management Outsourcing People/HR Issues
Project Management Relationship Management Risk Management
Stores Management Supplier Management Supply Chain
______
CIPS Australasia Application for Membership ABN: 32 111 330 262 Page 1 / 5
6.Routes to Membership
I intend to/am currently studyingCIPS qualifications:
I will be studying:
______
CIPS Australasia Application for Membership ABN: 32 111 330 262 Page 1 / 5
Level 3 Certificate in P & S
Level 4 Foundation Diploma in P&S
Level 5 Advanced Diploma in P & S
Level 6 in Purchasing & Supply (P & S)
______
CIPS Australasia Application for Membership ABN: 32 111 330 262 Page 1 / 5
I intend to study CIPS Qualificationsvia: (please tick one)
E-Learning CIPS approved provider Self Study
I intend to/am currently studying through CIPSA Accredited University Programme:
Please specify:
Name of University/Institution:
Name of Course/Programme:
I intend to complete this in (year):
(See the list of CIPS Accredited Universities at
Assessments:
I wish to be assessed for the most suitable pathway leading to full membership (MCIPS)
Please return yourdetailed CV, Transcripts from any formal qualification achieved anda Job Description with this application for preliminary assessment.
Your individual pathway outcome will be sent to you shortly after your application is processed.
7.Declaration
I agree to abide by the CIPS Code of Ethics and to abide by any rules and regulations which may be applicable to its members from time to time. The Professional Code of Ethics is available on the website.
Signed: Dated:
8.Data Protection and Member Communication
Full details of the CIPS Code for Practice for Data Protection is on the website. CIPS and CIPS Australia will contact you with information regarding your membership and studies. We would also like to send you other information on other CIPS products and services from time to time.
HOME WORK
Please send written communication (including magazine) to:
Please send email communication (including newsletter) to:
I do not wish to receive email communication:
PAYMENT FORM
Select your appropriate rate(AUD)AustraliaNew ZealandSouth Pacific
Affiliate $385 $360 MCIPS/Associate/Diploma/Certificate (not studying) $385 $360
Retired Under 65 $193.50$185
(ALL rates above include AU$100 joining fee)
Student Members Part Time*$205 $186
Student Members Full Time*$50 $50
*Student Members including Associate, Diploma and Certificate members who are currently studying are required to evidence their study. Members wishing to apply for student membership need to be currently studying or purchase study materials at the time the membership application is submitted. For further details contact
(No joining fee applies for student applications)
TOTALAMOUNT DUE (including joining fee) $:
NB:All fees for Australia include GST. GST is not applicable to all other fees.
Please contact us for further details on Retired and Unemployed member rates.
.
Direct Debit
** Sign up for direct debit today and pay NO Joining fee($100.00)**
Please tick the box above to sign up for Direct Debit from your credit card. Sign for 3 years on either monthly or annual payments and pay NO joining fee or sign for one year and receive $50.00 off the joiningfee.
You will be required to notify us in writing to cancel direct debit.
Paying by Cheque OR Money Order? (Please tick)
Please make the cheque payable to ‘CIPS Australia’ and secure it to your application form with your name marked clearly on the back of the Cheque.
Paying by Credit/Debit card?(Please tick)
Visa MasterCard American Express Diners Club A 3% surcharge applies for all Amex & Diners payments
Card No: Cardholder Name: Expiry Date:
Please debit: AUD $Add 3% Surcharge for Amex or Diners(if applicable)
CIPSA Member Referral Programme
I have been referred by:Name:
Membership Number:
Please visit website for terms and conditions of CIPSA member referral programme
Completed forms can be emailed, faxed or posted to the details below:
THISDOCUMENT IS A TAX INVOICE/RECEIPT WHEN PAYMENT IS MADE IN FULL
CIPS Australia Pty Ltd, Level 8, 520 Collins St, Melbourne VIC 3000.t. +61 3 9629 6000f. +61 3 9620 5488
e. w. ABN: 32 111 330 262 CIPSA0910 rev 18/2/10
______
CIPS Australasia Application for Membership ABN: 32 111 330 262 Page 1 / 5