Membership Form

Fiji Australia Alumni Association (FAAA)
Membership Registration Form

PERSONAL DETAILS

First Name:
Last Name:
Date of Birth:
Gender:

CONTACT DETAILS

Email Address (personal):
Email Address (work):
Phone Contact (home):
Phone Contact (work):
Phone Contact (mobile):
Facebook Name (optional):
LinkedIn Url:

ADDRESS

Street Name:
PO Box /Street Number:
Village or Suburb:
Town/City (leave blank if rural):
Division:
Country:
Are you living with a disability?
[radio* radio-disability "Yes" "No"]
If yes, please briefly explain your disability:

EDUCATION DETAILS

Name of highest Qualification:
Institution attended:
Year completed:

INDUSTRY / EMPLOYMENT DETAILS

Sector of Employment:
Current position:
Current employer:

MEMBERSHIP CATEGORY

Please select one:
[radio* radio-membercategory use_label_element "Regular Member: a person who has successfully completed a course or courses of academic study from any Australian-Government approved and registered Australian education institution, or through any Australian Scholarships Program" "Associate Member: a person or entity who can identify with and support the mission, objectives and purposes of the Association, but who may not have studied through an Australian institution." "Honorary Member: a person that has been granted membership by the Executive Committee in recognition of their past, present or affirmed contribution to the Association."]