Membership Forms

MMSA Profile Information for Membership

Salutation(*)

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Other salutation
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First Name(*)
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Surname(*)
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Scholarship(*)

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Year of Menzies Award(*)
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E-mail(*)
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Phone (Please include area code)(*)
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Current Position(*)
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Current Company / Organisation
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Career history/highlights(*)
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Leadership Roles(*)
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Professional/Other affiliations
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Public Service
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Willingness to act as mentor(*)
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Interests
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Personal Details – Release Consent Form

I hereby authorise elected committee members of the MMSA and staff of the Menzies Foundation to distribute via email, webpage, postal mail, or other such means, the contact details I nominate in this form for the purpose of networking and communication within the MMSA and the Menzies Foundation only.

I understand that my consent will continue until I advise via writing or email that I withdraw my consent.
Personal Details Consent(*)
Please provide your consent

Anti-Spam(*)
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