Student Membership Application Form

For any enquiry, please contact sovann.eu@vicwise.org

Membership Fee:

Student – non-transferable Membership is $10 + GST, valid for one year (Jan – Dec).

Applicant information

Status

Active Date

Expire Date

First Name*

Last Name*

Middle Name

Are you under 18?*

Country of origin*

What type of visa do you currently hold?*

Type of visa - Other

Phone Number*

Email Address*

Suburb*

Post Code/ZIP Code*

Type of current/latest education*

Name of current/latest education institution*

Current/latest course name*

Started year*

Graduation year*

Why do you want to join VicWISE?*

How did you hear about VicWISE?*

How did you hear about VicWISE - Other

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

Password*