Individual Membership Application Form
ABN 73 917 799 818
Inc. Assoc. No. A0039738V
Yes, I would like to: Join WIC Join the WIC Mailing List
Phone: (work hours)
Please tell us a little about yourself:
Who do you work for? Public Sector Private Sector Education Other
What brought you into this industry? Formal Training Opportunity Other__________________
How long have you been in this industry? Less than 2 yrs 2 – 5 years 5 to 10 years 10+ years
How long do you envision yourself to Less than 1 yrs 1 – 5 years Rest of Career Unsure
remain in this industry?
How would you describe your current Cadet Operational Middle Manager Senior/Exec Manager
If you are interested in participating in one of the WIC committees, please tick appropriate box:
Membership Events Champion Activities Marketing & Communication Media & PR
$50.00 Individual Membership (please note that a free membership is included if you purchase the entire
Hot Breakfast Series – visit WIC’s website for further details)
FREE Full-time Students/Mailing List
More information on WIC membership can be found at: http://www.wic.org.au/membership.aspx
Paypal (online at http://www.wic.org.au/membership.aspx)
Credit Card (VISA/MASTER) Card Holder Name: Expiry Date: .
Card Number: .
EFT DETAILS – WIC, NATIONAL AUST BANK, BSB No: 082 962, Account No: 4873 45608 quoting your name
Please record your payment receipt #
Please complete this form & return to: emailWIC@gmail.com
RECEIPT / INVOICE – This document will become your RECEIPT / INVOICE when completed & payment is made in full so please
keep a copy for your records. As a non-profit organisation with turnover below the GST threshold, GST does not apply.
PRIVACY DISCLAIMER – The collection of these details is primarily so that we can register you as a member of WIC. This
information will be stored in the WIC database and may be used for future marketing of WIC’s Events. If you do not wish your details to
be made available, please tick this box [ ]. If you do not tick the box, then WIC will consider that the individuals completing this form
consent to their personal details being used in the manner indicated.
Women in Information & Communication Contact: WIC Secretary
GPO Box 2579 Email: firstname.lastname@example.org
CANBERRA ACT 2601 Website: http://www.wic.org.au
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