Home → Membership → Membership Application New Membership Application New Your Name •TitleMrMrsMsMissDrProfThe HonourableJusticeBrigadierPhone Number •Please specify at least oneOfficeHomeMobileEmail Address •Date of Birth Day12345678910111213141516171819202122232425262728293031MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear2008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Postal Address •StateACTNSWNTQLDSATASVICWADistinctions/Degrees eg. Master of Philosophy (MPhil) at Australian National UniversityPresent Appointment Curriculum Vitae/Welcome Letter •Please attach an up to date copy of your Curriculum Vitae or Univeristy House Welcome LetterAre you an ANU employee? • Yes NoMembership status you are applying for • Ordinary — $110.00 Retired — $55.00 Current ANU Student — $27.50 New ANU Staff/ANU 1st Year PHDPartner Card Required •Please note, this will incur an additional $27.50 Yes NoPartner Name •TitleMrMrsMsMissDrProfThe HonourableJusticeMailing List I agree to receive occasional correspondence via... Email Post✓ All correspondence will be sent via email Membership Membership Application New Members Login