Membership Application

For any membership inquiries please contact the Membership Officer membership@greg.asn.au

Name

Given name

Family name

Address

Line One

Line Two

Suburb

Postcode

Phone

+61

Qualification

Discipline

Year of Conferring

Institution

Name of the University, College, or Institution conferring the qualification

Please include the city and country if outside of Australia

Highest Qualification

Discipline

Year of Conferring

Institution

Name of the University, College, or Institution conferring the qualification

Please include the city and country if outside of Australia

If you are applying for a student membership please complete this section

Name of Institution

If outside Australia, please include the city and country

Course Studying

Student Number

Year

Anticipated year of graduation

Name of Employer

Enter your practice name if you are self-employed

Address of Employer

Are you a member of another professional organisation?

Engineers Australia

Institute of Public Works Engineering Australasia (IPWEA)

Professionals Australia

Other (please specify)

Membership Fee Remittance

Grade	Membership fee
Engineer	$20 per annum
Associate	$20 per annum
Full Time Student	Free, but must provide valid student status each year
Part Time Student	Classed as an Associate, but may apply to the committee for a fee reduction

Bank account name

GREG Inc.

Bank

Bendigo Bank

BSB №

633-000

Account №

173 185 653

Please include your SURNAME and INITIALS in the comments or payee reference box

Please email me a tax invoice

If a Tax Invoice is required to be made out to other than your employer, please indicate who to.

Please note:

Membership is not valid until payment has been received.

Membership renewal is due on the 1^st of January each year.

Declaration

By submitting this form and paying the annual subscription fee I hereby agree to abide by the rules and charter of GREG Inc. and certify that the information provided here is correct.