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Membership Application

Regional Corporate Membership Application Form

You are invited to renew or apply for our subsidised Institutional Membership of Educate Plus for an annual fee of $550 (excl GST). This subsidised Institutional Membership provides you with 5 full memberships (each additional member $100). The Membership is subject to approval by the Chapter President and the CEO and will be reviewed annually.

"*" indicates required fields

Account Contact Name*
International format
Address

Member 1

You can nominate up to 5 members as part of your institutional membership. Please provide details of each member below:
Name
Special Interests
If ‘Other’ ticked, please include interest above.

Member 2

Name
Special Interests
If ‘Other’ ticked, please include interest above.

Member 3

Name
Special Interests
If ‘Other’ ticked, please include interest above.

Member 4

Name
Special Interests
If ‘Other’ ticked, please include interest above.

Member 5

Name
Special Interests
If ‘Other’ ticked, please include interest above.

Additional Member Details

Please include member names and contact details below. To add additional members, please hover mouse to right of ‘Professional Interests’ field. Click to add row. Each additional member costs $100 (plus GST). Please add each member’s professional interests so that we can provide them with tailored information relevant to their role: Admissions, Alumni & Community Relations, Fundraising, Marketing & Communications, Events, Leadership or People & Culture.
Name
Work Title
Email Address
Phone
Professional Interests
 

Institution's Executive Team Contact Details

To ensure our records are current, pleases list the following Institution’s Executive Team members’ contact details
Leader / Principal / Head's Name
Business / Finance Manager's Name

Mentoring

Invoicing

Once this form is submitted and received, an invoice will be drawn up and emailed to you. Click on the Submit button below to complete your Application.

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