REGISTRATION FORM

The annual registration subscription is:
  Registration for Membership dues are - AUS$ 195 (US$ 150)
Registration for Members of IAPC, AAPC, EAPC & ALACOP - AUS$ 130 (US$ 100)
   I confirm my understanding and acceptance of the APAPC CODE OF ETHICS
CONTACT DETAILS
Name of Contact Person:
*
Title :
*
Company Name :
*
Business Activity :
AdvertisingDirect Marketing
LobbyistMedia
Political ConsultantResearch
Other 
Street Address :
*
City :
*
Country :
Postal Code :
*
Telephone : ( ) *
Facsimile : ( )
Email : *
Web Site : http://
PAYMENT DETAILS
Please charge my credit card AUS$_____________
 
Mastercard American Express
Visa Diners Club International
Note: Credit cards will be charged in Australian Dollars.
Card Number :
Name as it Appears on Card :
Signature :
Expiry date :
OR

Enclosed is a cheque/money order for AUS$_____________
payable to The Asia Pacific Association of Political Consultants.

 * = Required
FAX to : + 61 3 96114911 Attention Secretariat