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I wish to:
(please indicate as applicable)

Become an Associate Member of APLEC
Renew my Associate Membership of APLEC
 
I enclose my cheque for $Aus 66.00 (inc $6.00 GST) for a calendar year (January to December)
Please make your cheque payable to
Leo Cussen Institute
Name:
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Postal Address:
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Country:
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TAX INVOICE
Print off and send completed form to:
APLEC Membership
C/- Leo Cussen Institute (ABN 16 949 282 178)
GPO Box 853K
MELBOURNE VIC AUSTRALIA 3001

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