Membership Application Form

	Membership * New Renewal Name: * Name of Spouse: E-mail: * Address: * City: * State: * NSW VIC ACT QLD WA NT TAS Post code: * Phone: * Mobile: For Family Memberships Please List Children names and date of birth Payment Method * I have Paid by EFT I will forward a cheque Other, please contact me I/We hereby apply for membership of the Australian Residents AI Association and agree to abide by the rules and regulations laid out in the Memorandum of Association. To reduce Spam Please enter Text in box: *