Membership Application Form Membership of the HRLA is for the calendar year from 1 January to 31 December. Title Name * First Name Last Name Institution/employer * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * Country (###) ### #### Membership Type * AUD $60 - ordinary membership AUD $30 - student/not employed/retired membership Payment * Enter the amount that has been paid by direct deposit to: Bank: Commonwealth Bank of Australia A/c name: Human Rights Law Association BSB: 064-001 A/c No: 1229 0682 (Reference: your initial and family name) $ Agreement * I wish to become a member of the Human Rights Law Association. In the event my application to be a member is accepted, I agree that I will support the purposes of the Human Rights Law Association and I agree to be bound by the association rules of the association (as amended from time to time). Thank you!