Q Group Application For Membership

Please fill out all fields before submitting

Please enter your name
title
preferred name
first name
middle names
last name
Work phone number
Work facimile number
Email address

Address for Correspondence

Number & Street/Postbox:
Suburb/City:
State:
Postcode:

Employment Details

Employer:

Title/Position:

Number & Street/Postbox:

Suburb/City:

State:

Postcode:

Nature of work:

Number of years in existing employment:

Academic qualifications:

Previous experience in quantitative areas:

Active Contribution:
Members are expected to contribute actively to the various activities of the Q Group. Please provide
details of the ways in which you will be able to actively contribute. (For example: a seminar you
could present; skills you could bring as a committee member; external presenters you could provide; etc.)

Referee: (Q Group Member Yes No )

Referee's Name

Referee's Phone

Referee's E-mail

I hereby apply for membership of the Q Group