MEMBERSHIP APPLICATION FORM

BIAME NETWORK INC. MEMBERSHIP APPLICATION FORM

You have two options:
  • You can apply Online using this form, or
  • You can Print Out Another Form Here, that you can then fax, or mail to us. 

    NAMES
Last Name:      
First Names:  
    

ADDRESS
Street:        
City:          
State:           
Country:        
Area/Zip Code: 
    

TELEPHONE & OTHER CONTACTS
Home:       
Work:     
Fax:      
Mobile:   
Email:    
Website:  
    

Date of Birth:  
Occupation:     
    

I wish to become  
If already initiated, I was initiated on  by   
  If "Other", give name  
    

I enclose my Membership Fee of 
    

If you complete the Automatice Fee Payment Form below, the Membership Fee is A$55.00.
Without completing the Automatic Fee Payment Form it is A$60.00.

You may pay by credit card by filling in the Payment Authority below. 
     
    


    PAYMENT AUTHORITY
    

The total amount I am paying with my credit card is A$ 
    

My credit card is:  
    

Number:  

Valid from(mm/yyyy):  /    Valid to(mm/yyyy):  /
    

Date of Completion of this form is:

    REMEMBER TO PRINT THIS FORM FOR YOUR RECORDS USING YOUR BROWSER

    N.B.: You can make your Membership Fee and/or Training Fee payments automatically each year by credit card. To do this, fill in the Automatic Fee Payment Form. You save A$5.00 per fee by doing this.


    After submitting this form, you can return to this page to obtain a copy of the Vedic Mantra recording from our Shop. Using this recording initiates you into this Mantra and makes you eligible for Initiated Membership of the Network. Click Here to go to the Shop.

    ABOUT BIAME NETWORK DIRECTORY



    Produced by Biame Network Inc., P.O. Box 271, Seymour, Victoria 3661, Australia
    Telephone: 1800 244 254 (Freecall in Australia); +61 3 5799 1198 (International)
    Facsimile: +61 3 5799 1132
    Email: biamenet@eck.net.au
    Website: www.biamenetwork.net