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Online Membership Application Form

The Wireless Institute of Australia
ABN 56 004 920 745
PO Box 2042
Bayswater
Victoria 3153

Mr/Mrs/Ms
Given Names
Family Name
Preferred Name
Postal Address
City/Town
State
Postcode
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Callsign
Date Of Birth dd/mm/yyyy
Occupation
Home Telephone
Work Telephone (optional)
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Select Membership Type
* Student Member- Please provide evidence below of being a full time student.
**Concession Member- Please provide
pension health benefits card number.
*** Family Member - Please provide Name and Callsign of primary family member residing at the same address
I apply for membership of The Wireless Institute of Australia and agree to be bound by its Constitution.

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