Name
of Member (or Organisation if Corporate member):
Membership
Category (circle one): Corporate / Individual / Student
Postal Address (including contact person for Corporate member):
Phone:
Fax:
E-Mail:
Topics of Current Interest in Pattern Recognition:
Institution
Certification of full-time enrolment (if student member):
APRS
membership fees: Corporate $100, Individual $30, Student $15.
Please print this form and return with your remittance to:
Tony Adriaansen
Phone: +61 2 96532274
Mobile: +61 402388270
email: tony.adriaansen@gmail.com