Australasian Society for Human Biology
TAX INVOICE
ABN: 11 821 324 701
20___ Annual Membership
DATE:
MEMBER TO COMPLETE:
Name
Affiliation Address
email
Complete the following and return to the treasurer:
DESCRIPTION
ASHB Membership
if paid before April 30th
ASHB Membership
if paid after April 30th
AMOUNT
Full membership
Student membership
Associate membership
Full membership
Student membership
Associate membership
Life Membership
PAYMENT OPTIONS
1. Direct Debit (preferred for Australian members)
Account name: ASHB
Bank: Westpac
Branch: Aitkenvale, QLD
BSB number: 034212
Account number: 427132
Reference: Please include your name
2. Credit Card (Please complete the following:)
Card Type:
Credit Card Number:
Card expiry (mm/yy):
Name on card:
Payment amount:
Cardholder signature:
AU$40
AU$15
AU$15
AU$60
AU$22
AU$22
AU$325
TOTAL
CONTACT
Kate Domett (ASHB Treasurer)
College of Medicine and Dentistry
James Cook University
kate.domett@jcu.edu.au
Phone: +61 7 4781 5608
Fax: +61 7 4781 5945 ATTN: Kate Domett