Membership Form

Australian Privacy Foundation Inc.
ABN 38 904 502 598

Please print this form, fill it in, enclose a cheque, and post it to G.P.O. Box 1196, Sydney NSW 2001. (Or you can use our nice printable brochure in PDF format.)

We regret that facilities for on-line application and payment are not yet available. If you prefer to use electronic means, please do so as follows:

• copy-and-paste the whole of this web-page into an email to the APF Secretary, fill in the places where information or choices are requested, and make sure that your email makes the requested declaration over your standard signature block; and
• make a direct deposit to the APF bank account at Bendigo Bank, BSB 633 000 A/c No. 126 879 162 (including your surname, to ensure that it is credited to the right person).

For the Foundation's Privacy Statement, see below*

To: The Secretary, Australian Privacy Foundation Inc, G.P.O. BOX 1196, SYDNEY, NSW 2001.

Name in which the Membership is to be recorded on the Register of Members:

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If applicant is an organisation, name of Contact Person and title of their position:

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Postal Address: .............................................................................................................

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Email address (optional but strongly preferred): ....................................................

Contact telephone number(s) (optional): .................................................................

I declare that I/we support the Foundation's objects and purposes set out in Rule 3 of the Rules of Incorporation, as follows:

1. To protect the privacy rights of Australians, by means of research, awareness, education, the highlighting of privacy risks in all forms of technology and practices, and campaigns for new laws, regulations, codes, policies and practices, and amendments to existing laws, regulations, codes, policies and practices.
2. To focus public attention on emerging issues and technologies that pose a threat to the freedom and privacy of Australians.
3. To collaborate with consumer organisations, civil liberties councils, professional associations and other community groups on specific privacy issues.
4. To participate in and contribute to other national and to international privacy protection organisations and initiatives.
5. To provide information to industry associations and government agencies, and to cooperate with them wherever practicable, but to remain independent of them, and to be critical of them where necessary.
6. To pursue such additional objects and purposes as may facilitate the achievement of the preceding objects and purposes.

I/we apply for the category of membership ticked below.

I am paying as follows:

• I enclose a cheque in favour of Australian Privacy Foundation for the relevant fee indicated            O
• I have made a direct deposit to Bendigo Bank, BSB 633 000 A/c No. 126 879 162 (and provided my surname with it to ensure that it is credited to the right person)           O

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Signature: ......................................................................... Date.................................

Member Involvement

What interests and expertise do you have in the area of privacy?

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Are you prepared to do voluntary work for the APF such as reviewing and preparing comments on discussion papers and submissions?

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Other comments:

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Rules of Incorporation. See the Foundation's Rules of Incorporation, at http://www.privacy.org.au/About/RulesofInc.html

Privacy Statement. Personal information is collected for the purpose of administering the affairs of the Australian Privacy Foundation and communicating with members. It is handled in accordance with the National Privacy Principles. For further details see the Foundation's Privacy Policy, at http://www.privacy.org.au/PrivacyPolicy.html

Categories of Membership and Schedule of Fees

(Please Tick Category of Membership Applied For)

ORDINARY MEMBER

O Annual Fee $40 (renewals in 2006 only: $25)

O Annual Fee - Concession/student (please provide details) $10

O Life Membership Fee $275

ASSOCIATE MEMBER
Not-For-Profit Organisations and Small Organisations (fewer than 5 employees)

O Annual Fee $220

O Life Membership Fee $660

Other Organisations

O Annual Fee $1100

O Life Membership Fee $3300

Donation

O Additional Amount $ ............................

Contribution to specific campaign (please specify):

O Additional Amount $ ............................

Total payment

O TOTAL AMOUNT $ ............................

OFFICE USE ONLY

Application approved: [Date] ........................................

Application fee received: [Amount} ........................................

Method of Payment: Cheque [ ] / Cash [ ] / Direct [ ]

Monies banked: [Date] ........................................

Member notified: [Date] ........................................

APF thanks its site-sponsor:

Last Amended: 18 January 2006 by Roger Clarke - Site Last Verified: 11 January 2005
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