MEMBER APPLICATION - GROUP RELATIONS AUSTRALIA Title — Select — Mr Mrs Ms Mx Dr Prof Other Name * First Last Gender — Select — Male Female Other Rather not say Nationality Work Role & Official Title Email Address * Mobile Number * Postal Address * State / Country * Are you a member of any related organisations? (e.g. AK Rice Institute, Group Relations India etc.) How/where did you hear about Group Relations Australia? * Max 100 words Why do you wish to become a member of Group Relations Australia? * Max 100 words Short Professional Biography (will be shared with other members) * Max 300 words Please attach a recent digitial photo in portrait style (Max 3MB. Preferably .jpeg file) * Select Image Member Category — Select — Member ($200) Student ($100) Member Agreement By submitting this application, I express my commitment to the purpose and aims of the Association, and in the event of my admission as a Member, I agree to be bound by the rules of Group Relations Australia Inc. for the time being in force.