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
* 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 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:
GSI Australia
e mail: info@gsiaustralia.com online: www.gsiaustralia.com		Ph: +61 7 40952500 Fax: +61 7 40953831