Professional Membership Form

Professional Membership Application Form

For any enquiry, please contact membership@vicwise.org

Type of memberships

Professional (non-transferable) - $100 + GST, valid for one year (Jan-Dec)

Professional (transferable) - $150 + GST, valid for one year (Jan-Dec)

Applicant information

Status

Start Date

Expire Date

Title*

First Name*

Last Name*

Position/Job title*

Organisation name*

Street address

Suburb/Town*

State/Province

Post code/ZIP code*

Phone number*

Email address*

Separator

Terms & Conditions*

.*

.

I have read and agree with the terms and conditions of VicWISE

Password*

VicWISE acknowledges the Traditional Custodians of the lands we are on and pays respect to their Elders past, present and future. VicWISE recognises and respects their cultural heritage, beliefs and relationship to their ancestral lands, which continue to be important to The First Nations Peoples living today.

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