HERDSA - Higher Education Research and Development Society of Australasia Inc.

MEMBERSHIP RENEWAL

TAX INVOICE
ABN 89 341 252 166

The form below can be completed and submitted electronically (together with credit card details), or printed and mailed or faxed to HERDSA together with your payment.

All payments are in Australian dollars (AUD), except New Zealanders pay in their own currency when using cheques. New Zealand credit card payments will be deducted in Australian dollars.

Please make cheques payable to HERDSA Inc

Bankcard, Visa and Mastercard, Amex & Diners Club are accepted.

Renewal Form

Howmbership Type:

Standard membership AUD$140.00
Retiree membership AUD$85.00
Student membership AUD$85.00

Your Details

Title:
Surname:
First Name:
Howmbership No:
Email Address:

Payment

	Cheque made out to HERDSA in Australian dollars, except New Zealanders may write cheques in their own currency
	Credit card (enter details below)

Card Type:
Cardholders name:
Card number:
Expiry date of card:	(MM/YY)

Please note: Credit card details are NOT stored on this site.

For postal or faxed orders:

Cardholders signature:	..................................................................................................
Today's date:	.......... / ........... / ............

Print this page for mailing or faxing

HERDSA Office, PO Box 27, Milperra NSW 2214 AUSTRALIA
Phone: +61 2 9771 3911 Fax: +61 2 9771 4299 Email: office@herdsa.org.au

TAX INVOICE ABN 89 341 252 166

Renewal Form

Your Details

Payment

For postal or faxed orders:

TAX INVOICE
ABN 89 341 252 166