Associate member application

Please select your membership category*

Personal Details

Name*

Title First Name Surname Post nominals

Preferred Name

Date of Birth*

Qualifications

Referred by

Other Professional memberships

Please list any other professional organisations of which you are a member

Email Addresses

Primary email*

Please supply two email addresses to receive important membership information and news. This will ensure we can contact you should you change employers

Secondary email

Personal Contact Details

Phone

Mobile

Personal Address*

Street address Suburb State Post Code Country

Professional Contact Details

Position/Job Title

Organisation Name

Phone*

Fax

Professional Address*

As Above

Street address Suburb State Post Code Country

Preferences

Preferred mailing address*

How would you like to receive the Society's Brief journal*

Area of Practice

Please nominate your area(s) of practice. Hold Ctrl to select multiple areas

Professional Interests

Please nominate your area(s) of interest. Hold Ctrl to select multiple areas

Agreements

Disclosure of membership*

I acknowledge

Unless you notify the Society otherwise in writing:
(a) your new membership status will be listed in the Society's Brief journal; and
(b) it is assumed that this Society is authorised to disclose the fact of your membership to any reputable organisation which the Society might be associated with if that association results in benefits to the Society

Member Agreement*

I acknowledge and agree that:

My membership is subject to the Constitution of the Society (as amended from time to time).

Privacy Statement*

I acknowledge

LAW SOCIETY OF WA (INC) COLLECTION NOTICE: The Society collects the personal information contained in this form pursuant to the provisions of the Privacy Act, 1988 and the Australian Privacy Principles. The information is collected by the Society to enable it to deal with the matters the subject of this form and to provide its services and benefits (and the benefits and services of the Law Council of Australia) to its members and the public. Those services and benefits are set out on the Society’s website (lawsocietywa.asn.au). If the information collected in this form is not provided, the Society may not be able to provide its services as effectively. Individuals who wish to access information held about them, who wish to make any complaints or who wish to obtain details about information which is disclosed by the Society to overseas recipients may do so by accessing the Privacy Collection Notice located on the Society’s website or may contact the Society’s Privacy Officer. USE OF PHOTOGRAPHY: The Society reserves the right to use photography and filming from its events for future promotional use. Please advise a Society staff member at each event if you wish to opt out.

Please upload supporting documents

Drop files here or

(i.e. copy of Practicing Certificate, proof of employment, academic transcript)

Notes

Please make additional notes regarding your application