Affliate Membership Application Surname * Given Names * Name of Business * Street Address Line 1 * Street Address Line 2 * City * State * ACTNSWNTQLDSATASVICWA Postcode * Postal Address Line 1 * Postal Address Line 2 * City * State * ACTNSWNTQLDSATASVICWA Postcode * Business Phone * Email * Please indicate your current employment situation * Self employed Partnership Employee Government employee Other (please state)Other (please state) Please indicate your preferred payment schedule * AnnualMonthly Declaration * I HEREBY APPLY for Affiliate Membership of the Australian Institute of Conveyancers WA Division and agree to abide by the Constitution and Code of Conduct. Subscription is $985.00 (GST Inc) annually or $89.83 (GST Inc) monthly. You will be invoiced once your application has been approved. Signature * signature keyboard Clear APPLY