AIPA Membership Application for Qantas Mainline

Australian & International Pilots Association

Application for Membership (Qantas Mainline)

Personal Details

Name*

First Name

Last Name

Middle Name

Gender*

Date of Birth*

Email Address*

Mobile Phone*

Please do not include spaces

Home Phone

Please do not include spaces

Home Address*

Address Line 1

Address Line 2

City

State

Postcode

Postal Address (if different to Home Address)

Address Line 1

Address Line 2

City

State

Postcode

Professional Details

Staff Number*

Aircraft Type*

Base*

Date of Employment*

Rank*

Designated Beneficiary

The Australian and International Pilots Association ("AIPA") has a Welfare Scheme which provides your designated beneficiary with a payment in the event of your death whilst you are a financial member of AIPA. This amount is currently $15,000 *however this is subject to annual review by the Committee of Management. You are requested to keep this information up to date in accordance with AIPA's Privacy Policy.

Name of Designated Beneficiary*

First Name

Last Name

Designated Beneficiary Phone Number*

Address of Designated Beneficiary*

Address Line 1

Address Line 2

City

State

Postcode

Relationship*

Designated Beneficiary Email Address

The Agreement

I,*

Full Name

being eligible for membership of the Australian and International Pilots Association ("AIPA"), hereby apply for membership and undertake to comply with all the provisions, conditions and stipulations in AIPA's Rules currently in effect or as varied from time to time with all lawful directions made under the Rules. (Click HERE to read the AIPA Rules)

Signature*

[clear]

Use your mouse or finger to draw your signature above

Date*

*Please complete the Subscription Deduction Authority (CLICK HERE) to ensure your AIPA Membership application is complete.

AIPA's Privacy Policy

The above information is collected for the purpose of processing an application for your membership of AIPA. The information collected will be stored in AIPA's membership database. AIPA uses your information for the primary purpose of communicating with you and advising you of the benefits associated with membership. You will be able to update your personal information stored in AIPA's database each time you log in to AIPA's website. Any changes you make to your personal information via the website will automatically update AIPA's database. You can also update your personal information any time by telephoning AIPA. Upon becoming a member of AIPA, you authorise AIPA to collect personal information about you from the Qantas Group, relevant to the personal information you have already provided to AIPA, and to modify AIPA's database accordingly. AIPA will not disclose any personal information obtained from you to a third party without your consent. AIPA's Privacy Statement can be viewed at www.aipa.org.au