This AIJA Membership enrolment form will be a tax invoice when accompanied by payment.

Notice: Undefined variable: err in /home/aija/public_html/membership.php on line 220

Surname*
First Name*
Title*	Mr Mrs Ms Dr Prof A/Prof Justice Judge Other
Organisation Name
Position/Occupation
Mailing Address*
Suburb*
State*	NSW VIC QLD SA WA NT ACT TAS Outside Australia
Country*
Postcode*
Telephone *
Facsimile
Email
Membership Type*	$AU120.00 Individual Membership Australia $AU375.00 Corporate Membership Australia $AU110.00 Individual Membership Overseas $AU350.00 Corporate Membership Overseas
Name on Credit Card*
Credit Card Number*
Expiry Date*
Credit Card Type*	Visa Mastercard American Express
Amount AU$
	(If you need a copy, print before you submit the form)