AONA Membership Online Application Form

Type of Membership
	Full (RN)	Associate (EN)

Type of Application
	Renewal	New Membership

Personal Details
Title
Surname
Given Name(s)
Street Address
City / Town
Postcode
Home Telephone

Place of Work (Hospital, etc)
City / Town
Postcode
Work Telephone
Email
Present Position

Change of Details Have you changed your Address or Place of Work?
Home Address
Place of Work
Both Home & Work

Acceptance of Rules
	By ticking this box, I hereby agree to abide by the rules of the Australian Ophthalmic Nurses Association.

Membership Fees
Full $50.00	(Due 1st March each year)
Associate $40.00	(Due 1st March each year)
Badge $10.00	(Optional)

Payment Details
	Direct deposit: BSB: 112-879 Account Number: 027866891 Remitter: Name (Insert own name)
	Cheque / money order (payable to Australian Ophthalmic Nurses Association) Australian Ophthalmic Nurse's Association PO Box 3292, GPO Sydney NSW 2001

Registration for Annual Conference
I wish to Attend
I will pay Early Bird
I will pay Regular

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