APPLICATION

To become a member of the Global Studies Institute- Australia
*       Fill out this form then either
*       Select the send button below to register online
Print *      Or Print out this form and post to
*      GSI Australia, Quinlan Road, Yungaburra, Queensland, 4872, AUSTRALIA
*      Make sure to organize payment either online or enclosed in posting

Organization: (opt)

Contact Person:

Email Address:

Postal Address:

State:

Country:

Zip / postal Code:

Telephone: 

Facsimile: (opt)

MEMBERSHIP TYPE - (please add student information at the bottom)

1 year Individual membership - (US)$25.00
3 year Individual membership - (US)$50.00
1 year Organizational Membership - (US)$400.00

PAYMENT METHOD

Check - make check payable to: Global Studies Institute Australia

Bank Transfer - Please include your name as a reference in Bank Transfer
          BANK BRANCH: TBA
          BSB: TBA
          ACCOUNT NUMBER: TBA
          ACCOUNT NAME: TBA

Credit Card Payment - - please select card type:
Visa                MasterCard              American express
Print If Faxing this application please print this form then fill out your credit details below otherwise click Send Application at the bottom of this form and use our Secure Server to make an online payment

Card Number:

 

Expiry Date:

 

Name on card:

 

Signature:

 

 

 FOR STUDENTS ONLY

Date of Birth:

College name:

College address:

Course enrolled:

Date of graduation:

Topics of interest:



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GSI Australia

e mail: info@gsiaustralia.com
online: www.gsiaustralia.com

Ph: +61 7 40952500

Fax: +61 7 40953831