Journal Subscription Form

Please print out the form below and forward it, with the payment of fees, to the Treasurer:

: Dr A. Howe; Treasurer, Australian Mathematical Society; Department of Mathematics; Australian National University; ACT 0200; Australia.

New members should also fill out the Membership Application Form and send that with this subscription form. Note that due to the introduction of a Goods and Services Tax in Australia, payment for journals must now be made to the Australian Mathematical Publishing Association Inc (AMPAI) rather than to the Society.

Details of the subscription fees.

We regret that at present we cannot accept electronic applications as we are not yet able to handle secure transmission of credit card details.

PERSONAL DETAILS (Please print or type)


Surname: ............................................................

Other names: ........................................................

Title: ........

Address for publications:

   ..................................................................

   ..................................................................
   
   ............................................Postcode: ............

Membership type (Please circle the appropriate response)


  Ordinary      Sustaining       Reciprocal      Reduced-rate

I am resident in

  
  Australia          Overseas



PUBLICATIONS (Please circle the appropriate responses)

I wish to receive:

                               Cost (A$)

    Journal Series A           ........ 

    ANZIAM Journal             ........  

    Bulletin                   ........


    TOTAL                      --------




PAYMENT

The total sum for journal subscriptions for the current year is

$..............

EITHER:

1. I enclose a cheque for $....... made out to the AMPAI

OR:

2. Please debit my (circle one):

   Mastercard      Visacard       Bankcard     American Express


   Card number: __ __ __ __  __ __ __ __  __ __ __ __  __ __ __ __

   Card Expiry Date: .............................................

   Card Holder Name: .............................................

   Signature: ........................... Date: ..................
   
   Amount: AU$.............

I require a receipt:        YES            NO