Australasian Institute of Emergency Services - Corporate Membership Application Form

Application for Corporate Membership of the Australasian Institute of Emergency Services

Instructions
Please use this on-line form to apply for corporate membership of the Australasian Institute of Emergency Services.

Please Note
Please address your application using the drop-down-box to your local Division of the Institute or the Division that represents the area where your organisation is based.

All fields marked with * must be completed.
The Divisional Registrar processing your application will contact you with details of the progress of your application once it has been received.
The annual cost of Corporate Membership is $500. Each Corporate Member will receive an Institute Plaque in recognition of their support.
Payment must accompany this application. On submission of this application form you will be redirected to our secure payment portal. Payment can be made using Credit Card or PayPal.
Please do not enter < or > characters into this form as it may be blocked for security reasons.

Application Form

* To: The Divisional Secretary of

* Organisation Name

* First Name

* Last Name

* Position / Title

* Phone

* Email

* Confirm Email

* Street Address

* Suburb or City

* State

* Please specify state

* Post Code

* Country

I hereby apply for admission to the Australasian Institute of Emergency Services as a Corporate Member.

Please include details of any Emergency Management component to your organisation or involvement with the Emergency Services:

(max 2000 characters)

Please Enter Any Additional Details You Wish To Have Considered In The Box Below (max 2000 characters)

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Please Note

Submitting this form is the same as signing a hard copy. By submitting this form you declare the above particulars to be true and hereby agree to be bound by the Constitution, By-Laws and Code of Ethics of the Institute.