membership form

To become a member or to renew your membership, please fill in this form, sign it, and return it with a copy of your identification, concession ID (if applicable) and payment.

All individual applicants need to provide identification, such as a copy of a driver's licence or a household bill with their current address. Concession holders need to provide a copy of either their Senior's Card, healthcare card or a student card.

You can fill in this form online - type directly into each box, then print it out - or you can print it out and fill it in by hand. If you have any difficulty using this form, you can contact ACMI Collections on (03) 8663 2467 between 9am and 5pm, Monday to Friday (AEST).

Send to:

ACMI Collections
PO Box 14
Flinders Lane
Melbourne, Victoria 8009

ACMI respects your privacy.

your details
title
first name
last name
organisation
department
client number
address (please ensure identification is attached)

suburb
state
postcode
telephone
alternative telephone
mobile
facsimile
email address	(correspondence will be via email if you provide an address)

your interests
(complete only if new member) The following information assists us to identify areas of interest to our members as we expand the Collection to meet our members' needs.
What is your age?
Which of the following types of film genre interest you (Tick all relevant boxes)	Feature films
	Foreign films
	Documentaries
	Television programs
	Children's films
	All
Where did you first hear about the ACMI Collection?
Are you currently enrolled in a Cinema Studies Course?	Yes No
Do you wish to borrow 16mm films?	Yes No
If yes, please complete a 16mm Application Form and return it with this form.

yearly membership

regional member
full membership - $95
Entitles regional members up to six titles per fortnight.
concession membership - $70
Entitles regional members with concession (valid seniors, healthcare or student card) up to six titles per fortnight.

schools
basic membership - $95
Entitles the school up to four titles per week (metropolitan) or six titles per fortnight (regional). Note that while ACMI Collections provides outward freight direct to schools, all return freight is the responsibility of the borrower.
special membership - $150
Entitles the school up to eight titles per week. Provides extra 'schools-only' benefits, including regular newsletters, an individualised catalogue on a topic of choice and an extra fine waiver each year.
organisations
non profit organisations (community groups, film societies, etc.) - $95
Entitles the organisation up to four titles per week (metropolitan) or six titles per fortnight (regional).
commercial organisations and tertiary institutions - $150
Entitles the organisation up to four titles per week (metropolitan) or six titles per fortnight (regional).

payment details
	I wish to pay by cheque and enclose a cheque for the amount of
	or
	Please debit my credit card for the amount of

credit card details
name of cardholder
card type	Visa Mastercard Bankcard
card number
expiry
date

signature	_________________________________

collection and returns
	Collect from the following public library:
	Eligible for outward freight (schools only)

Please read the lending service - conditions of loan before signing this form.

declaration
I have read and understand the lending service - conditions of loan, including the Copyright information, and understand that failure to observe these conditions may result in the cancellation of my membership.
date

signature	_________________________________

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