*Note: Please print and mail with your payment.

INTERNATIONAL INSTITUTE FOR PEACE THROUGH TOURISM (AUSTRALIA) INCORPORATED  Application for Membership  Name…………………………………………………………………………………………… Position……………………………………....................................... Company……………………….…………………................................ Address……………………………………………………………………………….………... Phone (     )………….……........... Fax (     )…………………............. E-mail……………………………….............................. Membership Category……………… Enclosed is cheque made payable to IIPT (Australia) Inc  (ABN 74 168 052 823) or please charge: [  ] Visa  [  ] Mastercard for $………  being payment of $……….for 2006-2007 membership fee and donation (optional) of $………….  Card Number. ................................................... Name on Card……………………………………..Expiry Date…………………… Signature…………………………………………..Date…..……………………….. Please mail this membership form with your payment to: IIPT (Australia) Inc. G P O Box 670 Sydney NSW 2001  Australia Further Information from:  Daphne Lowe Kelley, President IIPT (Australia) Incorporated Phone/Fax (61 2) 9719-3080 E-mail lowekelley@bigpond.com Web site  www.iipt.org   Back to Australia Chapter

 
International Institute for Peace Through Tourism