Membership Form
Australian Institute of Physics
Please print out this form, or download the electronic version in Word
6.0 or RTF format, fill in and forward to:
1/21 Vale Street, North Melbourne, VIC 3051, Australia
Application for admission or transfer to the grade of
Subscriber|Associate|Student|Graduate|Member|Fellow (circle one)
1. ALL APPLICANTS
Family Name_________________________________________ Title______________________
Given Names_______________________________________________________________
Address___________________________________________________________________
Postcode________ Tel______________ Fax______________Email____________________
2. SUBSCRIBERS ONLY
Signature_____________________ Date______________________________
No further questions need to be answered by subscribers.
3. STUDENTS ONLY
Tertiary Institute Attended____________________________________________________
Degree Course__________________________________________________________________
Verification by member of staff:
I certify that the above named person is a student of Physics at this
Institute/University, undertaking a degree which can lead to a Physics
major and recommend him/her for admission as a Student member of the Australian
Institute of Physics.
Signature_____________________ GAIP/MAIP/FAIP Name___________________ (Block
Capitals) Student applicants please complete section 5 below
4. ASSOCIATES, GRADUATES, MEMBERS, FELLOWS.
Degree(s) held (with years(s) of Graduation)_______________________________________________
Conferring Institute(s)/University(ies)____________________________________________________
Current Employer_________________________________________________________________
Position held____________________________________________________________________
Please attach (1)An official transcript of academic record (2)
Brief statement of employment history since graduation (3) List of publications,
patents or other evidence of professional standing appropriate to the level
of membership being applied for.
STATEMENT BY PROPOSER
The proposer should be a member of the Institute in a grade at least
that equivalent to that sought by the applicant
I am acquainted with the applicant's career in Physics and propose him/her
for admission to the grade of
Associate | Graduate | Member | Fellow of the Australian Institute of Physics.
Signature__________________ GAIP/MAIP/FAIP Name___________________________(Capitals)
STATEMENT BY SUPPORTER (for applicants for Fellowship only)
As a Fellow of the Institute, I am acquainted with the applicant's career
in Physics and propose him/her for admission to the grade of Fellow
of the Australian Institute of Physics
Signature__________________ FAIP Name________________________________(Capitals)
5. DECLARATION
If admitted to the Australian Institute of Physics, I agree to be
bound by the bylaws and rules of the Institute and will advance the objects
of the Institute so far as is in my power.
Signature______________________________ Date_______________
Membership committee use only:
Grade approved: (1)
Date admitted: (2)
Register number_______________________ Hon Registrar___________________________
