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n	 Home n Business
Chapter Affiliation
n	 Chapter Number (see reverse)______________
	or
n 	Member at large (no chapter within 50 miles/80 km)
AUSTRALIA MEMBERSHIP APPLICATION
Join online and save US $20.00
www.isaca.org/join	
n MR. n MS. n MRS. n MISS n OTHER _______________	 Date________________________________		
MONTH/DAY/YEAR
Name__________________________________________________________________________________________________________________________________	
	FIRST	 MIDDLE	 LAST/FAMILY
_______________________________________________________________________________________________________________________________________
PRINT NAME AS YOU WANT IT TO APPEAR ON MEMBERSHIP CERTIFICATE
Residence address______________________________________________________________________________________________________________________		
STREET	
______________________________________________________________________________________________________________________	
CITY	 STATE/PROVINCE/COUNTRY	 POSTAL CODE/ZIP
Residence phone	 ___________________________________________________ 	 Residence facsimile_____________________________________________	
AREA/COUNTRY CODE AND NUMBER	 AREA/COUNTRY CODE AND NUMBER
Company name	 ______________________________________________________________________________________________________________________
Title	 ______________________________________________________________________________________________________________________
Business address	 ______________________________________________________________________________________________________________________		
STREET	
______________________________________________________________________________________________________________________	
CITY	 STATE/PROVINCE/COUNTRY	 POSTAL CODE/ZIP
Business phone	 ___________________________________________________ 	 Business facsimile _____________________________________________	
AREA/COUNTRY CODE AND NUMBER	 AREA/COUNTRY CODE AND NUMBER
E-mail	 ______________________________________________________________
Please complete both sides
U.S. Federal I.D. No. 23-7067291
Phone: +1.847.660.5505 • Fax: +1.847.253.1443
Email: membership@isaca.org
Member Get A Member Referral Information
If you have been referred by an ISACA
member, please enter the ISACA
Member ID# that was provided to you.
Referring Member ID# ______________
How did you hear about ISACA?
n ISACA Chapter
n ISACA Event
n ISACA Journal
n Career Centre
n Do not remember
n Email
n Employer
n Friend/Colleague
n Postal Mail
n Professor/Teacher
n Publication
n Social Media
n Tradeshow/Seminar
n Web Advertisement
n Web Site Reference
n Other
Please note: Membership in the association requires you to belong to a chapter when you live or work within 50 miles/80 km of a chapter territory. The name of the chapter is indicative of its territory. If you live
farther than 50 miles/80 km from a chapter territory, select member at large. Chapter selection is subject to verification by ISACA International Headquarters. Cities listed in parentheses are a reference to where the
majority of chapter meetings are held. Please contact your local chapter at www.isaca.org/chapters for other meeting locations.
Current field of employment (check one)
n Advertising/Marketing/Media
n Aerospace
n Education/Student
n Financial/Banking
n Government/Military—National/State/Local
n Health Care/Medical
n Insurance
n Legal/Law/Real Estate
n Manufacturing/Engineering
n Mining/Construction/Petroleum/Agriculture
n Not applicable
n Pharmaceutical
n Public Accounting
n Retail/Wholesale/Distribution
n Technology Services/Consulting
n Telecommunications/Communications
n Transportation
n Utilities
n Other ___________________
Level of education achieved (indicate degree achieved, or
number of years of university education if degree not obtained)
n one year or less
n two years
n three years
n four years
n five years
n six years or more
n AS Degree
n BS/BA Degree
n MS/MBA/Masters
n Ph.D
n Not applicable
n Other __________
Work experience
(check the number of years of information systems
related work experience)
n No Experience
n 1-3 years
n 4-6 years
n 7-9 years
n 10-12 years
n 13 years or more
n Not applicable
Current professional activity (If not your title, please select the BEST match)
n CEO, President, Owner, General/Executive Manager
n CAE, General Auditor, Partner, Audit Head/VP/EVP
n CISO/CSO, Security Executive/VP/EVP
n CIO/CTO, Info Systems/Technology Executive/VP/EVP
n CFO, Controller, Treasurer, Finance Executive/VP/EVP
n Chief Compliance/Risk/Privacy Officer, VP/EVP
n IT Audit Director/Manager/Consultant
n Security Director/Manager/Consultant
n IT Director/Manager/Consultant
n Compliance/Risk/Privacy Director/Manager/Consultant
n IT Senior Auditor (External/Internal)
n IT Auditor (External/Internal Staff)
n Non-IT Auditor (External/Internal)
n Security Staff
n IT Staff
n IT/IS Compliance/Risk/Control Staff
n Professor/Teacher
n Student
n Other	
Birth Year________________________________________________
Certifications obtained
(other than CISA, CISM, CGEIT, CRISC)
n ACA
n CA
n CFE
n CIA
n CISSP
n CPA
n MCSE
n PMP
n Other __________
Payment due
• International dues =		 $ 148.50 (US) ($135.00 + $13.50 GST)
• Chapter dues (see reverse)	 $ 	 (US)	
• New	member	processing	fee	 $ 33.00 (US)* ($30.00 + $3.00 GST)
	
PLEASE PAY THIS TOTAL	 $	 (US)
= For student membership information please visit www.isaca.org/student
*	 Membership dues consist of international dues, chapter dues and new member
processing fee. Join online and save US $20.00.			___
Membership dues are nonrefundable and nontransferable.
Mail your application and check to:
ISACA • 1055 Paysphere Circle • Chicago, IL 60674 • USA
Method of payment
n Check payable to “ISACA” in US dollars, drawn on US bank
n MasterCard n VISA n American Express n Diners Club n Discover
All payments by credit card will be processed in US dollars
Credit Card # ____________________________________________
Print name of cardholder __________________________________
Expiration date ___________________________________________                
MONTH/YEAR
Signature_________________________________________________	
By applying for membership in ISACA, members agree to hold the association and its chapters, and
the IT Governance Institute, and their respective officers, directors, members, trustees, employees and
agents, harmless for all acts or failures to act while carrying out the purposes of the association and the
institute as set forth in their respective bylaws, and they certify that they will abide by the association’s
Code of Professional Ethics (www.isaca.org/ethics).
Full payment entitles new members to membership from the date payment is processed by
International Headquarters through 31 December 2019. No rebate of dues is available upon early
resignation of membership.
Contributions, dues or gifts to ISACA are not tax deductible as charitable contributions in the United
States. However, they may be tax deductible as ordinary and necessary business expenses.
Your contact information will be used to fulfill your request to become an ISACA member, and may
also be used by ISACA to send you information about related ISACA goods and services, and other
information in which we believe you may be interested. As an ISACA member, we will be sure
to keep you up-to-date on the latest products and services that are available to our community.
By applying for membership, you confirm the information provided on this form is complete and
accurate, and you authorize ISACA to contact you at the address and numbers you have provided,
including to provide you with marketing and promotional communications. You further represent
that the information you provided is yours and is accurate. To learn more about how we use the
information you have provided on this form, please read our Privacy Policy, available at www.isaca.
org. Should you elect to attend one of our events or purchase other ISACA programs or services,
information you submit may also be used as described to you at that time.
ISACA requires members to provide certain demographic information to help us understand and better serve our constituents, and to ensure that we deliver information that is relevant to you.
The dues amounts on this application are valid 1 August 2020 through 31 May 2021.
US dollar amounts listed below are for local chapter dues. While correct at the
time of printing, chapter dues are subject to change without notice. Please include
the appropriate chapter dues amount with your remittance.
For current chapter dues, or if the amount is not listed below, please visit
the web site, www.isaca.org/chapdues, or contact your local chapter at
www.isaca.org/chapters.
OCEANIA
Adelaide, Australia †	68	 $30
Brisbane, Australia †	44	 $30
Canberra, Australia †	92	 $30
Melbourne, Australia †	47	 $20
Perth †	 63 	 $30
Sydney, Australia †	17	 $35
† Cost includes AUS GST.
To receive your copy of the ISACA Journal, please complete the following subscriber information:
Size of ENTIRE organization
n Fewer than 50 employees
n 50 - 149 employees
n 150 - 499 employees
n 500 - 1,499 employees
n 1,500 - 4,999 employees
n 5,000 - 9,999 employees
n 10,000 - 14,999 employees
n 15,000 or more employees
n Not applicable
Size of IT audit staff (local office)
n 0 individuals
n 1 individual
n 2-5 individuals
n 6-10 individuals
n 11-25 individuals
n More than 25 individuals
n Not applicable
Size of information security staff
(local office)
n 0 individuals
n 1 individual
n 2-5 individuals
n 6-10 individuals
n 11-25 individuals
n More than 25 individuals
n Not applicable
Your level of purchasing authority
n Recommend Products/Services
n Approve Purchases
n Recommend and Approve
n Not applicable
Chapter	Chapter
Name	 Number	Dues

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Australia professional-membership-application frm-eng_0720

  • 1. Send mail to n Home n Business Chapter Affiliation n Chapter Number (see reverse)______________ or n Member at large (no chapter within 50 miles/80 km) AUSTRALIA MEMBERSHIP APPLICATION Join online and save US $20.00 www.isaca.org/join n MR. n MS. n MRS. n MISS n OTHER _______________ Date________________________________ MONTH/DAY/YEAR Name__________________________________________________________________________________________________________________________________ FIRST MIDDLE LAST/FAMILY _______________________________________________________________________________________________________________________________________ PRINT NAME AS YOU WANT IT TO APPEAR ON MEMBERSHIP CERTIFICATE Residence address______________________________________________________________________________________________________________________ STREET ______________________________________________________________________________________________________________________ CITY STATE/PROVINCE/COUNTRY POSTAL CODE/ZIP Residence phone ___________________________________________________ Residence facsimile_____________________________________________ AREA/COUNTRY CODE AND NUMBER AREA/COUNTRY CODE AND NUMBER Company name ______________________________________________________________________________________________________________________ Title ______________________________________________________________________________________________________________________ Business address ______________________________________________________________________________________________________________________ STREET ______________________________________________________________________________________________________________________ CITY STATE/PROVINCE/COUNTRY POSTAL CODE/ZIP Business phone ___________________________________________________ Business facsimile _____________________________________________ AREA/COUNTRY CODE AND NUMBER AREA/COUNTRY CODE AND NUMBER E-mail ______________________________________________________________ Please complete both sides U.S. Federal I.D. No. 23-7067291 Phone: +1.847.660.5505 • Fax: +1.847.253.1443 Email: membership@isaca.org Member Get A Member Referral Information If you have been referred by an ISACA member, please enter the ISACA Member ID# that was provided to you. Referring Member ID# ______________ How did you hear about ISACA? n ISACA Chapter n ISACA Event n ISACA Journal n Career Centre n Do not remember n Email n Employer n Friend/Colleague n Postal Mail n Professor/Teacher n Publication n Social Media n Tradeshow/Seminar n Web Advertisement n Web Site Reference n Other Please note: Membership in the association requires you to belong to a chapter when you live or work within 50 miles/80 km of a chapter territory. The name of the chapter is indicative of its territory. If you live farther than 50 miles/80 km from a chapter territory, select member at large. Chapter selection is subject to verification by ISACA International Headquarters. Cities listed in parentheses are a reference to where the majority of chapter meetings are held. Please contact your local chapter at www.isaca.org/chapters for other meeting locations. Current field of employment (check one) n Advertising/Marketing/Media n Aerospace n Education/Student n Financial/Banking n Government/Military—National/State/Local n Health Care/Medical n Insurance n Legal/Law/Real Estate n Manufacturing/Engineering n Mining/Construction/Petroleum/Agriculture n Not applicable n Pharmaceutical n Public Accounting n Retail/Wholesale/Distribution n Technology Services/Consulting n Telecommunications/Communications n Transportation n Utilities n Other ___________________ Level of education achieved (indicate degree achieved, or number of years of university education if degree not obtained) n one year or less n two years n three years n four years n five years n six years or more n AS Degree n BS/BA Degree n MS/MBA/Masters n Ph.D n Not applicable n Other __________ Work experience (check the number of years of information systems related work experience) n No Experience n 1-3 years n 4-6 years n 7-9 years n 10-12 years n 13 years or more n Not applicable Current professional activity (If not your title, please select the BEST match) n CEO, President, Owner, General/Executive Manager n CAE, General Auditor, Partner, Audit Head/VP/EVP n CISO/CSO, Security Executive/VP/EVP n CIO/CTO, Info Systems/Technology Executive/VP/EVP n CFO, Controller, Treasurer, Finance Executive/VP/EVP n Chief Compliance/Risk/Privacy Officer, VP/EVP n IT Audit Director/Manager/Consultant n Security Director/Manager/Consultant n IT Director/Manager/Consultant n Compliance/Risk/Privacy Director/Manager/Consultant n IT Senior Auditor (External/Internal) n IT Auditor (External/Internal Staff) n Non-IT Auditor (External/Internal) n Security Staff n IT Staff n IT/IS Compliance/Risk/Control Staff n Professor/Teacher n Student n Other Birth Year________________________________________________ Certifications obtained (other than CISA, CISM, CGEIT, CRISC) n ACA n CA n CFE n CIA n CISSP n CPA n MCSE n PMP n Other __________ Payment due • International dues = $ 148.50 (US) ($135.00 + $13.50 GST) • Chapter dues (see reverse) $ (US) • New member processing fee $ 33.00 (US)* ($30.00 + $3.00 GST) PLEASE PAY THIS TOTAL $ (US) = For student membership information please visit www.isaca.org/student * Membership dues consist of international dues, chapter dues and new member processing fee. Join online and save US $20.00. ___ Membership dues are nonrefundable and nontransferable. Mail your application and check to: ISACA • 1055 Paysphere Circle • Chicago, IL 60674 • USA Method of payment n Check payable to “ISACA” in US dollars, drawn on US bank n MasterCard n VISA n American Express n Diners Club n Discover All payments by credit card will be processed in US dollars Credit Card # ____________________________________________ Print name of cardholder __________________________________ Expiration date ___________________________________________                 MONTH/YEAR Signature_________________________________________________ By applying for membership in ISACA, members agree to hold the association and its chapters, and the IT Governance Institute, and their respective officers, directors, members, trustees, employees and agents, harmless for all acts or failures to act while carrying out the purposes of the association and the institute as set forth in their respective bylaws, and they certify that they will abide by the association’s Code of Professional Ethics (www.isaca.org/ethics). Full payment entitles new members to membership from the date payment is processed by International Headquarters through 31 December 2019. No rebate of dues is available upon early resignation of membership. Contributions, dues or gifts to ISACA are not tax deductible as charitable contributions in the United States. However, they may be tax deductible as ordinary and necessary business expenses. Your contact information will be used to fulfill your request to become an ISACA member, and may also be used by ISACA to send you information about related ISACA goods and services, and other information in which we believe you may be interested. As an ISACA member, we will be sure to keep you up-to-date on the latest products and services that are available to our community. By applying for membership, you confirm the information provided on this form is complete and accurate, and you authorize ISACA to contact you at the address and numbers you have provided, including to provide you with marketing and promotional communications. You further represent that the information you provided is yours and is accurate. To learn more about how we use the information you have provided on this form, please read our Privacy Policy, available at www.isaca. org. Should you elect to attend one of our events or purchase other ISACA programs or services, information you submit may also be used as described to you at that time. ISACA requires members to provide certain demographic information to help us understand and better serve our constituents, and to ensure that we deliver information that is relevant to you. The dues amounts on this application are valid 1 August 2020 through 31 May 2021.
  • 2. US dollar amounts listed below are for local chapter dues. While correct at the time of printing, chapter dues are subject to change without notice. Please include the appropriate chapter dues amount with your remittance. For current chapter dues, or if the amount is not listed below, please visit the web site, www.isaca.org/chapdues, or contact your local chapter at www.isaca.org/chapters. OCEANIA Adelaide, Australia † 68 $30 Brisbane, Australia † 44 $30 Canberra, Australia † 92 $30 Melbourne, Australia † 47 $20 Perth † 63 $30 Sydney, Australia † 17 $35 † Cost includes AUS GST. To receive your copy of the ISACA Journal, please complete the following subscriber information: Size of ENTIRE organization n Fewer than 50 employees n 50 - 149 employees n 150 - 499 employees n 500 - 1,499 employees n 1,500 - 4,999 employees n 5,000 - 9,999 employees n 10,000 - 14,999 employees n 15,000 or more employees n Not applicable Size of IT audit staff (local office) n 0 individuals n 1 individual n 2-5 individuals n 6-10 individuals n 11-25 individuals n More than 25 individuals n Not applicable Size of information security staff (local office) n 0 individuals n 1 individual n 2-5 individuals n 6-10 individuals n 11-25 individuals n More than 25 individuals n Not applicable Your level of purchasing authority n Recommend Products/Services n Approve Purchases n Recommend and Approve n Not applicable Chapter Chapter Name Number Dues