ABN 61 170 338 903

  PRESIDENT: David Wardell B.Ed., Adv.Dip.Tchg, M.A.A.I.C.
Irlen Diagnostic Clinic
Suite 5, Pakuranga Professional Centre
267 Pakuranga Rd, Pakuranga, Auckland, NZ
Ph: +64 9 5765390

 SECRETARY: Mrs B. Freney, PO Box 733 Buderim, QLD 4556, Ph: (07) 5445 2458

 

Application for Membership

AAIC – The Australasian Association of Irlen Consultants Inc.

Category: Regional Director  Fee:AUD $66.00 NZD $74.00 (voting rights)

Text Box: Name …………………………………………………………………… Address ……………………………………………………………….. State ……………. Postcode ………………… Country ……………. Phone ………………………… Fax ……………………….. Email ……………………………………………………

 

Category: Associate Members – Clinic Directors, Diagnosticians,  screeners and Pre-Assessors   Fee: AUD $33.00 NZD$37.00 (speaking rights)

Text Box: Name: ………………………………………………………………………………….. Category:(Clinic Director, Diagnostician, Screener, etc.)…………………………………………………………………… Name of Regional Director in whose area you work: …………………………………. Address: ………………………………………………………………………………... State……………. .Postcode ………. Country ………………………….. Phone: …………………………… Fax: …………………………….. Email: …………………………………………………………………

 

Category: Honorary Member. No Fees charged.  By nomination only.

 

For payment options see over page.

 

 

 

 

 

 

Fees: In Australia are payable to the treasurer Peter Freney, P.O. Box 733, Buderim Q 4556

 

 

PAYMENT METHODS in Australia.

              Cheque, made out to Treasurer, AAIC . Post to address above.

                            

              Direct payment into bank account, details as follows:

                        Bank: National Australia Bank.  Account Name: Aust. Assoc. of Irlen
                        Consultants   BSB: 082 372   Account No:   671653854   Please use
                        your name for Reference. This is most important or we won’t know
                        who has made the payment!            

 

              Pay by credit card, either by phone 07 5445 2458, or fill out the slip
                        below and post.

_____________________________________________________________________

 

Please debit my Bankcard          Visa           Mastercard  

 

Number:             

Note:    The last three numbers are the three security numbers which are the last three on the signature strip on the back of the card.

 

Expiry Date:  ...............    Signature:..............................    

 

Name:..............................

 

Amount to be paid:  $.   

 

Thank you.

 

Peter Freney

Treasurer AAIC