CPCA Membership Registration Form

Personal Information (* items must be filled in)

        *Title:                 Mr. Mr. Mrs. Miss. Ms. Dr. A/Prof. Prof.

        *FirstName:            *Surname:

        *Sex:  Male   Female

        *Year of Birth (e.g.1965) 

          Place of Birth: (e.g.Beijing, Sydney, etc.) 

        *Email Address: 

          Marriage:   Married   Single

        *Member Type:   Individual Member   Family Representative   Spouse Family Member
          (You may join in CPCA as a family member(Represnetative/Spouse) or as an individual member.)

        Authorization Code:(Code must be combination of letter and number only.)
          (For "Family Representative", you need to create a code for your spouse registration. For "Spouse Member", you need to enter the code to indentify your relationship with family representative.)

        Family Representative ID:
          (For "Spouse Member", you must enter your family representative ID to verify your registration as Spouse Family Member.)

        *Year of Joining in CPCA

          Home Address: 

        *Suburb:              

          State:     NSW NSW VIC SA WA NT QLD TAS ACT       *Postal Code:    

          Telephone(Work):          *Telephone(Home or Mobile): 

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Professional Information (* items must be filled in)

         *Company or Institution:
          
      
         Company/Institution Address: 

       *Position/Job Title: 
        (If you are a student, just fill in "student".)

       *Specialty/Course Major:
        (You can enter your either current or previous expertise. If you are a student, fill in the course name you are taking like "High School", "Computing Science".)

       *Higest Qualification:
             *from Institution: 

       Professional Membership:
        (e.g. Member of IAF (Institute of Australian Forester), IEEE, Australian Legal Association, or Board member, etc)

       Position or duties outside your main work area:
        (e.g. editor of Australian Forestry, PhD supervisor, president of other association or club, etc)
      

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Personal Interests

        Interesting Activities:

	Sports	Seminar	Karaoke_Dance	Mental Games(Cards and Chess)
	eGames	Tour & Trip	Cooking Art & Wine Culture	Quiz & Joke
	Movies & Shows	Debates & Chats

        Interesting Seminar Topics:

	Kids Education	Finance & Investment	Health & Medicine	Cultural Dicussion
	Science & Technology	Tourist & Hoppies

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I have read the Constitution of CPCA and Privacy Statement of CPCA. I agree with the CPCA Constitution and CPCA Privacy Statement.