ࡱ> bda_ bjbjkk 4H;\;\C 0008hL|03t00"RRR 03232323232323$%57`V3!%|!!V3RRk33$3$3$!XRR033$!033$3$1h<2RB]!h13303x1;8";8 <2;8<2:3$HV3V3#3!!!!;8 > :  Membership Application EDA [Member Economic Development Australia] To become a member of EDA, you must work in or have an interest in Economic Development activities ACEcD [Australian Certified Economic Developer] To become an ACEcD you must Be a financial member of EDA Have at least 10 years relevant experience in an economic development role Commit to continued professional development and achieve 50 PD points over each two year period Please indicate below whether you are applying for membership, and/or applying for accreditation  Membership ACEcD Section 1 Personal Details Please complete all field marked with an asterisk Title: Dr, Councillor, Mr, Mrs, Ms [please circle one] *First name: ________________________________ *Surname _________________________________ *Position Title: ____________________________________________________________ *Organisation: ____________________________________________________________ Month & year commenced employment: ________________________________________ *Organisations Address: ____________________________________________________ Suburb: ___________________________________ State: _____________ Post Code: __________ *Work Phone (_____ ) _______________________ Fax: ( ______ ) ____________________________ *Email: _______________________________________________________________________________ Home address: _________________________________________________________________________ Suburb: _____________________________ State: ________________ Post Code: _________ Home phone: [_____ ] _______________________ Mobile: ___________________________________ Section 2 Tertiary Education Qualification /Degree  Institution Year completed    Section 3 Work Experience Years Position & Organisation  Responsibilities* Contact details of referee [to verify skills & experience for ACEcD]    * contact details not required unless applying for ACEcD Section 4 Payment details (not required of current member applying for accreditation only) EDA Membership is $400.00 pa [incl GST] Credit Card: Type of Card Mastercard Visa Card Number ___________________________________________ Expiry date [MM/YY] _______/_______ Name on Card ________________________________________ Signature of Card Holder _______________________________ Cheque Cheques payable to Economic Development Australia EFT Economic Development Australia Limited Bank: Bendigo Bank Fountain Court Bendigo BSB: 633 000 Account 130303282 PERSONAL DECLARATION All members are required to support the Code of Ethics by reading and signing the declaration below Members shall exemplify the skills of the profession and act at all times with integrity, care and diligence Members shall seek to maintain and improve their professional knowledge, skills and competence Members shall observe legislation and regulation that governs their respective activities, as well as the spirit of the law and contemporary market place Members shall consider the effect of their actions on all relevant stakeholders and declare to those parties any conflict of interest Members shall exercise a duty of care such that their activities are capable of close public scrutiny I hereby declare that: The information in this application is true and correct. I authorize the investigation of all statements made by me with respect to this application. I declare that I have read EDAs Code of Ethics and Professional Practice and agree to be bound by EDAs Constitution, Regulations and this Code. Name of Applicant: _________________________________________________________ Signed: ________________________________________Date: _____________________     PAGE  Economic Development Australia Limited ABN 18 123 776 394 Lvl 1, 99 Bay St Brighton 3186 Postal: PO Box 84. 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