Brismesh Inc.
Individual membership application

m# (Office use only)

I hereby apply for individual membership of Brismesh Inc.:

Surname:
Given names:
Address:
Home phone:
Work phone:
Fax number:
Mobile:
Email:
Node number: from www.brismesh.org/db, required
Concession: Leave blank, or write 'student'

I certify that the above personal details are true and correct, and that I agree to abide by the policies and conditions which may from time to time be determined by the Management Committee of Brismesh. I have read the Privacy Statement at the end of this form.

I certify that I am over 18 years of age, or that I have parental consent to join Brismesh Inc. (Parent or guardian must sign in this case.)

Applicant
Signature Date
Proposer
Signature Date Member #
Seconder
Signature Date Member #
Guardian
(if required)
Signature Date

Please lodge your application with the association's secretary by posting a completed, signed copy to Brismesh Inc., Brismesh Inc., 412 Robinson Rd West, Geebung QLD 4034 or by sending a signed and scanned image (300dpi black&white GIF) to secretary@brismesh.org. Please send a notification email to the secretary anyway if you are using physical post.

Privacy statement

Brismesh Inc. requires the above information to contact you and to comply with relevant state regulations. Brismesh Inc. will not disclose your private information without your consent, except as required by law. Private information held about you by Brismesh Inc. may be obtained and/or corrected by contacting the Privacy Officer via secretary@brismesh.org.

Please note: Your name, and address may be made available to public requests to see the membership registry. Your email address may be made available to members of Brismesh Inc. and to their guests.

Application fee

Applications cannot be accepted unless accompanied by payment of the membership fee. If an application is rejected, the fee will be refunded in full. Student concession applications must be accompanied by presentation of a student card bearing a QR logo. The initial application fee varies as to the month of application, and the concession claimed. Membership renewal is due each year on July 1. You may enquire of your membership status, or cancel your membership by contacting the secretary. The initial fee schedule for ordinary members is as follows:

Month Ordinary Student
Jul, Aug $30.00 $15.00
Sep, Oct $25.00 $12.50
Nov, Dec $20.00 $10.00
Jan, Feb $15.00 $7.50
Mar, Apr $10.00 $5.00
May, Jun $5.00 $2.50

Payment can be made in cash at general meetings, by direct deposit (638-070/009302034), or by cheque (made out to "Brismesh Inc."). Please email treasurer@brismesh.org to notify of direct deposit payments.

Individual Membership Application Form r.20050525