APANA® Individual Membership Application Form

APANA^® Individual Membership Application Form

(Last updated - 16 February 2023)

Australian Public Access Network Association Inc.

NOTE: This web form automatically sends you a copy of the application form as well as sending it directly to the Treasurer.

If there are any errors or omissions on the copy you receive or you have any questions please contact the Treasurer by email.

APANA^® is the Australian Public Access Network Association Inc. (ARBN 081 355 722, VRN A0026600C). Application for membership can be made by completing this form in full and clicking on the "Submit This Application Form" below.

Completion of this form alone does not endow the applicant with any rights of membership or access to any member services or facilities.

This form is for individual membership only. Non-profit organisations wishing to apply for membership of APANA should use the Organisational Membership form instead.

All correspondence should be sent to:

                                 APANA Inc.
                                 77 Gerzalia Dr. 
    				George Town TAS 7253

On receipt of payment an email receipt will be sent to the address you provide below. In order to contain costs, printed receipts will only be sent via regular mail on request.

IMPORTANT: DO NOT OMIT ANY MARKED FIELD (*) OF THE FORM OR YOUR APPLICATION WILL BE REJECTED.

(Revision: 1.9 $Date: 2023/02/16)

Have you previously applied to join APANA? Yes No

Have you previously been a member of APANA? Yes No

PERSONAL AND CONTACT INFORMATION

The following information is required for APANA membership records and for us to contact you should the need arise. It will not be disclosed to third parties, without your written consent, except where required by law. Portions of this information will be recorded in our membership register which is available for public inspection, by law, upon request to the secretary. Phone numbers will not be made available for public inspection. Access to phone numbers will be restricted to APANA administrative personnel only.

As required by law (Associations Incorporation Act 1981 [Vic] and the Australian Securities and Investments Commission), this information will be permanently recorded in the membership database.

At all times any member of APANA and their guests will have access to your membership number, your name, whether you are a financial member or not, and your email address.

* Please indicate the APANA Region you wish to join:

* First Name(s):

* Surname:

* Postal Address:

* Postcode:

* Business Hours Phone Number:

* After Hours Phone Number:

* Contact E-mail address:

* Are you aged over eighteen? Yes No

(If not, please ensure that your parent or legal guardian signs at the appropriate place on this form.)

LEGAL DECLARATION

This declaration is required before your application for membership of APANA can be processed. Please be sure that you have read and understood both the Rules of Membership and the Network Acceptable Use Policy, included with any supplied information kit or via the World Wide Web site listed below, before signing this declaration.

APANA Network Acceptable Use Policy	Rules of APANA Inc.

http://www.apana.org.au/AUP.html	http://www.apana.org.au/Rules.html

I certify that the above personal details are true and correct and that I have been provided with a copy of the APANA Rules of Membership and the APANA Network Acceptable Use Policy and that I agree to abide by the conditions contained in those documents along with any new or altered policies or conditions which may from time to time be determined by the Management Committee of APANA.

* Signed:

GUARDIAN'S SIGNATURE (if applicant is under 18 years of age)

The Internet allows access to a wide range of information, some of which may offend or be considered inappropriate for people under 18. It is not possible for APANA to censor or control the information which can be accessed through the Internet. Members (and where the member is less than 18 years of age, their parents or guardians) take full responsibility for any information accessed via the APANA network. Your child can benefit enormously from access to the Internet. You may wish to explore this new environment with your child to better understand the issues surrounding it.

Signature of Parent/Guardian:

Signed:
Contact Phone Number:

Fee Schedule

Note: APANA is not an Internet Service Provider (ISP). It is a Computer Networking club with its own private network.

Fees are as follows:

The APANA Membership Fee ($50.00) is payable yearly in advance by all members. (This fee is used to cover the administration costs of APANA.)

Payment Options

Payment can ONLY be made by Direct Deposit at any branch of the Commonwealth Bank (cheque or cash) or by Electronic Funds Transfer to APANA's account as follows:

Account Name:	APANA Inc
Bank:	Commonwealth Bank of Australia
Branch:	367 Collins Street, Melbourne
BSB:	063-000
Account Number:	1017 3911
Statement Ref:	(Please enter your surname.)

APANA Email Contacts

APANA^® is the Registered Trademark of the Australian Public Access Network Association Inc.
APANA^® newsgroups^™, APANA^® network^™ and the APANA^® logo^™ are trademarks of the Australian Public Access Network Association Inc.

Have you previously applied to join APANA?	Yes No
Have you previously been a member of APANA?	Yes No

* Business Hours Phone Number:
* After Hours Phone Number:
* Contact E-mail address:

* Are you aged over eighteen?	Yes No