Membership Renewal - Laboratory Technicians' Association of Victoria

Member Name*

Name of school / institution*

Postal address of school / institution*

Street / Postal Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Phone*

Position in organisation*

Status*

Please give details of term of employment*

Have you registered at more than one school / organisation?*

Please indicate where you would like your Lablines sent

Region*

Payment Options

Choose your payment type*

LTAV 2023 Membership

Cost of LTAV membership for one year

Credit Card*

Card Details

Cardholder Name

Name

This field is for validation purposes and should be left unchanged.