Membership Information
&
Application form

Personal Details:

First Name

Last Name

Date Of Birth

Gender
Male Female

Address

City

State Select State New South Wales Queensland South Australia Tasmania Victoria Western Australia Australian Capital Territory Northern Territory

Postcode

Phone

Fax

Mobile

Email

Password

Confirm Password

Upload Profile Image

Upload Signature

Membership Fees

Bank Details: Bank of South Australia, BSB: 105 008, Account No: 065009540

Note: Please send your cheque or money order made out to:
The Treasurer, Australasian Association of Ayurveda Inc., 125 Stud Road, Dandenong, VIC 3175

Payment Method:

Declaration:

I , applying for General Membership with the Australasian Association of Ayurveda Inc, (A.A.A.) and declare that all the information provided with this application are valid and correct. I also declare that I have no prior criminal conviction in Australia or overseas.

I am aware that giving wrong or willfully incorrect information will result in cancellation of my membership, and may be prosecuted. I also undertake to abide with the terms and conditions of the code of Conduct and Ethics of the AAA. I allowed AAA to store my detail in their records and use the same for the communication such as newsletter and events.