Application for ASHB Membership

To apply for membership:
1) Type required information into all of the fields below
2) Print and post, along with payment, to:

Dr Debra Judge
(ASHB Treasurer)
School of Anatomy & Human Biology
University of Western Australia
35 Stirling Hwy
Crawley WA 6009

OR, if including card payment, FAX completed form - signed - to Debra Judge on (08) 6488 1051

The ASHB ABN Number is 11 821 324 701

If you need more information, or do not know two members of the ASHB to propose you, please e-mail Debra Judge.

Applicant status:

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Work details:
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Contact details:
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Note: your name and email address will be placed on the ASHB membership list unless you indicate that you do not consent to this by checking this box


Professional details:
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Current position:
Areas of human biology interest:
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Proposer:	(Green items to be completed by new applicants only)
Name:
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Seconder:
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Membership requested:
(Note: fees in Aust. dollars)	Full: $25pa (for those actively involved in the research, teaching, or practice of human biology) Associate: $15 (for those with an interest in the area of human biology) Student: $5 (for students not in receipt of a full salary) Life: $250 one-off payment

Method of payment:	Cheque enclosed Money order Visa Mastercard

If paying by credit card, please type in the following details:
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Payment amount:	$25.00 $15.00 $5.00 $250.00

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