AIPM - Part Time Student Application

Title
Surname *
Other Names *
Street Address / PO Box *
Suburb *
State
Postcode *
Country
Telephone *
Facsimile
Mobile *
Email *
Date of Birth *	(dd/mm/yyyy)
Name of School, University, TAFE *
Degree or qualification *
Duration of course *
Year of completion *	(dd/mm/yyyy)
Evidence of Part-Time student status All applications for Part Time Student Membership must be accompanied by a document proving the student is enrolled as a Part-Time student in an AIPM endorsed course (if nothing is available in soft copy, fax evidence to 02 8288 8711 Attn. Duncan Miller)
"I have read the AIPM's Code of Ethics and agree to abide by this Code. I have also read the AIPM's Constitution and agree to abide by the Constitution and to any Rules and By-Laws made in accordance with the Constitution."
* Indicates a mandatory field.