Membership form

Step 1 of 2 - Complete member details

Subscription period: 1 January to 31 December 2008.

Membership is considered lapsed if not renewed before 1 March 2008. It is available to individuals only and is not transferable.

Instructions:

Details provided on this form will be made available to co-ordinators of ARATA regional and special interest groups
Members are automatically subscribed to the arata-ls and included in the ARATA Membership Directory - you can unsubscribe below if you do not want to receive these services
ARATA does not currently have the security in place for you to pay online and membership fees will need to be forwarded by post or fax - please do not send credit card details via email

Personal identification

Title (Mr, Mrs, Ms, Dr, Prof):

First Name:

Surname:

Address

Street/PO Box:

Suburb/Town/City:

State/Province:

Post/Zip Code:

Country:

Contact information

Daytime phone number (please include area code):

Mobile phone number:

Facsimile (include area code):

Email address:

Membership services

Note: If you would like to be part of the ARATA Listserve and/or Membership Directory leave the following two questions blank or tick checkbox to unsubscribe.

No: I do not wish to be registered on the list serve.
No: I do not wish to be listed in the Membership Directory.
Yes: If available, I would like to receive the newsletter by email.

Member profile

Please tick more than one as applicable:

Consumer of rehabilitation and/or assistive technology
Family member, carer and/or advocate
Administrator
Librarian
Medical Practitioner
Nurse
Occupational Therapist
Orthotist / Prosthetist
Physiotherapist
Recreationalist
Rehabilitation Engineer
Special Education Teacher
Speech Pathologist
Teaching Assistant
Technician
Volunteer

Other:

Manufacturer/Supplier (Name of Comany):

Work related involvement (Name of Organisation):

Special Interest Groups

Please tick any of the SIGS you would like to particpate in

Augmentative and Alternative Communication
Service Delivery and Public Policy
Wheeled Mobility and Seating
Computer Access
Assistive Technology in Developing Countries
Human Perspectives of Technology Use
Telecommunications
Environmental Control
Education

Other:

Administrative information

How did you hear about ARATA?

Please tick to indicate agreement.

I agree to abide by the Association's Rules.

Payment details

Continuing Members [AU $50.00].
New or Lapsed Members [AU $75.00]

Please indicate if you would like to give a donation (optional):

Donation amount $

Instructions

BEFORE PROCEEDING: Please print a copy of this form for your records. It is also helpful to forward a copy with your membership fee to:

ARATA Treasurer,
Technical Solutions,
109 Ferndale Road,
Silvan VIC 3795

Selecting "Continue" will send a copy of this information to the ARATA Treasurer. However, your membership will not be approved until payment is received.

Selecting "Clear Form" will delete any information you entered above.

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