ICOM - International Council of Museums, Australia

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Title

First Name^*

Surname^*

Have you applied previously for membership of ICOM? Yes No

Institution Details

Institution Name^*

Position

Contact Details

Postal Address^*

Address 2

City/Suburb^*

State^*

Postcode^*

Country

E-mail

E-mail 2

Phone

Please indicate area code

Phone (M)

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Fax

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Institution's web address

Membership Details

Membership Category

Regular museum professional	$140.00
Retired museum professional	$65.00
Post-graduate Student (non-voting)	$55.00

Are you a member of Museums Australia?

Yes No. If so, please provide your membership number *You must check your number to receive a discount

Your application will be finalised upon receipt of appropriate support documentation as nominated by you below

	I am an employee/volunteer at a cultural institution and will forward supporting documentation by email to info@icom.org.au and/or post
	My name can be found at: URL Link

	I am a student and I will forward a copy of my enrolment summary by email to info@icom.org.au and/or post
	I am retired and formerly worked for:

ICOM Australia may ask you to submit further supporting documentation to help process your application.

Language for correspondence

English French

Language for publications

English French Spanish

Specialisation(tick maximum 4)

	Archeology		Historic Houses
	Architecture		Library / Archives
	Arms / Military History		Management / Administration
	Audio-visual		Marketing & Public Relations
	Cataloguing & Inventory		Modern Art
	Climate Control		Musical Instruments
	Collections Management		Planning
	Computers		Publications
	Conservation		Research
	Design / Installation		Restoration
	Education		Security
	Exhibition Management		Science / Technology
	Fine Art		Training of Personnel
	Glass		Visitor Services
	Other: Please Specify

Please indicate your preference for receiving
Correspondence from ICOM Australia
e-mail postal address either

ICOM Australia e-News
yes no

ICOM Australia sets out in its Privacy Statement how it collects, uses and discloses members' personal information. This statement is framed by the Privacy Act 1988 (Cth) and as amended. The Privacy Statement can be found at: www.icom.org.au/policiesprivacy.php

Information you provide on this form will be transmitted to third parties: ICOM headquarters and ICOM�s International Committees. You have the right to access and to modify your information. The French law on Informatics & Civil Liberties (Jan. 6, 1978, rev.) provides for the equivalent right. nt right

I authorise ICOM including ICOM Australia to publish my information on their websites (access to this information is restricted to ICOM Australia officers, ICOM Paris officers, ICOM committees, ICOM affiliated organisations & member services providers)
Personal Professional
I authorise ICOM including ICOM Australia to transmit my information to non-ICOM third parties (such as conference organisers, Museums Australia, printers, mail distributors etc)
Personal Professional

Please read ICOM Australia's conditions of purchase and bookings information.

^*I declare that I am eligible for membership of the International Council of Museums (ICOM) and wish to become a member of ICOM. I do not engage in dealing (ie. buying and selling for profit) in the field of cultural property anf accept the ICOM Code of Ethics for Museums.

Validation Code^*