www.ausimm.

com
Application for Member GRADE

INFORMATION AND FAQ

HOW LONG DOES IT TAKE FOR MY APPLICATION TO BE PROCESSED?

Once we have received your application it will take approximately four weeks for the application process to be completed (incomplete applications can
take longer). Your application is firstly checked for all necessary documentation and sponsors are verified. We will contact you to confirm receipt of your
application, provide you with a reference number and advise if further information is required. Each month all completed applications are forwarded to
the Applications Committee for review, the committee make recommendations to the Board for consideration and approval. These recommendations are
then placed on a ballot and forwarded to The AusIMM Board for approval. Confirmation of election, including a membership card, certificate and tax
receipt will be sent by mail to your nominated postal address.

HOW MUCH WILL MY MEMBERSHIP COST?

The cost of membership will depend on the grade to which you are applying. A once-off application fee also applies for most new or reinstating members
and reinstating members may be required to pay any outstanding arrears. Go to http://www.ausimm.com.au/main/membership/apply.php to calculate
your fees. Payment must be included for applications to be processed. For reinstatements and transfers, please contact the Membership Department
prior to submitting an application.

Qualifications and Experience

A copy of your CV and confirmation of your degrees, diplomas, etc should be included with this application form. The only exception is in the case
of reinstatement or grade transfer where required information has previously been approved. (If your degree is in a language other than English
please submit a copy in English).
The following forms of confirmation are acceptable: a) photocopy of the degree, diploma, etc certified by at least one sponsor as a true copy, or
b) formal statement from the tertiary institution specifying the degree, diploma, etc granted.

WHAT IF I DONT KNOW ANY AusIMM MEMBERS TO SPONSOR MY APPLICATION?

In special circumstances where you cannot obtain the necessary signatures from AusIMM Corporate Members, the Board may admit applicants on
production of satisfactory evidence of experience. Please contact the Membership Department in the first instance.

WHEN DO I RENEW MY MEMBERSHIP?

Annual subscriptions shall be payable by 1 January each year. Subscription invoices are sent to members in October of the preceding year.

WHAT IS AN APPLICATION UNDER BY-LAW 10b?

An application under By-Law 10b allows for applicants without a tertiary degree to apply for the grade of Member provided that the applicant has
...achieved professional status and a position of professional responsibility through a combination of formal post secondary education and experiential
learning, over a period of at least ten years whilst engaged in the minerals and extractive industries, or in government, education, research, professional
or commercial organisations directly concerned with those industries.
Referee statements from sponsors will be required for this type of application. These will be requested from the sponsors once an application has
been received and checked by the Membership Department.

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 www.ausimm.com
Application for Member GRADE
This electronic document has been made interactive for your immediate use. Once you have filled in the appropriate form fields and verified information
is correct, please hit the SUBMIT button and follow the prompts provided. If you wish to print and manually complete this document please fax it to
AusIMM on +61 3 9662 3662 or mail to PO Box 660, Carlton South VIC 3053 Australia.

If you are submitting this document by fax or mail please complete the GREEN response fields
If you are submitting this document electronically please complete the ORANGE response fields

PERSONAL DETAILS

Title: Mr Mrs Ms Miss Other Phone (BH):

First Name: Phone (AH):
Middle Name: Fax:
Last Name: Mobile:
Gender: Male Female DOB: Email:

Preferred Mailing Address: Residential Preferred Mailing Address: Business

City: State: Postcode: City: State: Postcode:
Country: Country:

Present Employer: Preferred Interest Division (PID):

Position: Mining Metallurgy Geoscience Environment
Site/Location: Management Other
APPLICATION DETAILS

Application Type: Admission Reinstatement Grade Transfer Current/Prior Membership No. (if applicable):
Are you applying for membership under By-Law 10b? (See Information and FAQ)

QUALIFICATIONS AND EXPERIENCE

Post-Secondary Education Membership of other Professional Bodies

A copy of your CV and confirmation of your degrees, diplomas, etc should be included with this application form. The only exception is in the case of
reinstatement or grade transfer where required information has already been approved. (If your degree is in a language other than English please submit a
copy in English). The following forms of confirmation are acceptable: a) photocopy of the degree, diploma, etc certified by at least one sponsor as a true copy, or
b) formal statement from the tertiary institution specifying the degree, diploma, etc granted.

If you are submitting this document by fax or mail: If you are submitting this document electronically:
Please fax the relevant documentation to AusIMM on +61 3 9662 3662 or Once this form has been completed, submit this form then attach
mail to PO Box 660, Carlton South VIC 3053 Australia along with this an electronic copy of the relevant documentation to the submission email.
completed form.

MEMBER DECLARATION

As a member of the AusIMM, I agree to observe and be bound by the terms of the By-Laws, the Code of Ethics or any other Code of The AusIMM and any rule
published by the Board prevailing at the relevant time, and I undertake to promote the aims and objectives of The AusIMM.

NAME: Date:

Signature: I agree to support the aims, objectives and By-Laws of The AusIMM
(Please tick box if you agree)

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 The Australasian Institute of Mining and Metallurgy
Ground Floor, 204 Lygon Street, Carlton VIC 3053 Australia
Postal Address: PO Box 660, Carlton South VIC 3053 Australia
Phone: +61 3 9658 6100 Fax: +61 3 9662 3662 Email: membership@ausimm.com.au

SPONSOR DETAILS
This proposal for admission to the grade of Member must be sponsored by 3 Corporate Members of The AusIMM (ie Honorary Fellow, Fellow or Member).
Contact Details of Sponsor No.1

First Name: Organisation:

Last Name: Job Title:
Telephone: AusIMM Membership No.:
Email: Grade of Membership: Member Fellow
Sponsors Signature: To the best of my knowledge the sponsor agrees to support this application
(Please tick box if you agree)

Contact Details of Sponsor No.2

First Name: Organisation:

Last Name: Job Title:
Telephone: AusIMM Membership No.:
Email: Grade of Membership: Member Fellow
Sponsors Signature: To the best of my knowledge the sponsor agrees to support this application
(Please tick box if you agree)

Contact Details of Sponsor No.3

First Name: Organisation:

Last Name: Job Title:
Telephone: AusIMM Membership No.:
Email: Grade of Membership: Member Fellow
Sponsors Signature: To the best of my knowledge the sponsor agrees to support this application
(Please tick box if you agree)

PAYMENT DETAILS: Payment must accompany this application form

Cheque Please make cheques payable to: The Australasian Institute of Mining and Metallurgy, at PO Box 660, Carlton South VIC 3053 Australia.
Australian currency (AUD) cheques only (Cheque payments applicable to mailed applications only).
Credit Card Please debit my Visa MasterCard Amex Diners Card
Card Number: Card Expiry: Amount: AUD $
Cardholder Name:
Cardholder Signature: I authorise this transaction
(Please tick box if you agree)

Subscription Fees
For new members go to http://www.ausimm.com.au/main/membership/apply.php to calculate subscription fees.
Reinstatements and Grade Transfers please contact the Membership Department prior to completing payment details.

ANNUAL RENEWAL DIRECT DEBIT FACILITY (OPTIONAL)

(Allow 7 working days to process) with an ongoing debit annually in accordance with Board approved subscription rates appropriate to my membership grade.
With the last debit date of: (Leave blank if until further notice).
Cardholder Name:
This authorisation is to remain in force in accordance with the terms and conditions on this page, and I/we have read and understood the same.
Cardholder Signature: I authorise this transaction Date:
(Please tick box if you agree) (Date must be completed)
DIRECT DEBIT TERMS AND CONDITIONS
I/we herby authorise The Australasian Institute of Mining and Metallurgy (herein referred to as The AusIMM) or its agent to make periodic debits as indicated on this Direct Debit Request. I/we acknowledge that the nominated debit amount will be
debited to my/our account according to the terms and conditions of the Direct Debit Request. I/we acknowledge that it is my/our responsibility to have sufficient funds available by the due date to permit a direct debit in accordance with the Direct Debit
Request. I/we have authorised the principal to vary the amount of the payments from time to time provided for in the Direct Debit Request. I/we acknowledge that if a debit is returned by my/our Financial Institution as unpaid, I/we will be responsible
for any late fee for each unsuccessful debit in addition to any Financial Institution charges and collection fees that may be incurred by The AusIMM. I/we acknowledge that a delay may occur in the processing of a debit if: (a) There is a public or bank
holiday on the day or on the day after a payment is due to be made by direct entry (b) A payment is received either on a day which is not a Banking Business day or after the normal close of business on a Business Banking day. I/we acknowledge
that variations to the debit arrangements should be directed to The AusIMM. I/we acknowledge that requests to stop or cancel debit arrangements should be directed to The AusIMM. I/we acknowledge that any disputed debit item should be directed
to The AusIMM. I/we acknowledge that my/our record and account details may be required by the Financial Institution in connection with a claim made on it relating to an alleged incorrect or wrongful debit, otherwise they will be treated as confidential.
I/we authorise the following: (a) The Debit User to verify the details of my/our account with my/our Financial Institution (b) The Financial Institution to release information allowing the Debit User to verify my/our account details. I/we acknowledge
that The AusIMM Privacy Policy can be found at www.ausimm.com. I/we acknowledge that I/we have a right to cancel a debiting authority, or make a claim for a particular debit considered to be wrongfully made directly to my financial institution.

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 The Australasian Institute of Mining and Metallurgy
Ground Floor, 204 Lygon Street, Carlton VIC 3053 Australia
Postal Address: PO Box 660, Carlton South VIC 3053 Australia
Phone: +61 3 9658 6100 Fax: +61 3 9662 3662 Email: membership@ausimm.com.au

APPLICATION CHECK LIST

1. Personal details completed 5. Accepted terms and conditions of Member Declaration

2. Application details completed 6. Provided sponsor details and obtained sponsor approval
3. Qualification details completed 7. Provided payment details
4. CV and degree/s attached 8. Authorised Annual Renewal Direct Debit (optional)
Once this form has been completed, please verify information given is correct, and fax or mail to:

Postal Address: The Australasian Institute of Mining and Metallurgy, PO Box 660, Carlton South VIC 3053 Australia.
Fax: (Att. Branches and Membership) +61 3 9662 3662

Once this form has been completed, please verify information given is correct, and

4SUBMIT THIS FORM 8 

OFFICE USE ONLY:

Member No.
Invoice No.

Verified Sponsor 1:
Verified Sponsor 2:
Verified Sponsor 3: