Thank you for your interest in becoming an Affiliate Member with AIM WA.

This introductory level of membership is complimentary, to apply please complete and submit the application form below.

A notification will be sent via email to advise when your application has been submitted successfully.

Please note: If you are already a registered AIM WA website user you may be asked to login to complete the application form. If you do not have a password simply select 'forgot password' and a new password will be emailed to you. If you are not currently a website user please enter your email address and complete the online application form.

Your Details

Please enter a valid email address.
Please enter a valid first name.
Please enter a valid middle name.
Please enter a valid last name.
Please select a valid title.
Please enter a valid preferred name.
Please select a valid gender.
Please enter a valid date of birth.
Please enter a valid nationality.
Please enter a valid phone type.
Please enter a valid phone number.
Please enter a valid mobile phone number.
Please enter a valid position title.
Please enter a valid organisation name.
Please enter a valid address.
Please enter a valid address.
Please enter a valid address.
Please enter a valid suburb.
Please enter a valid postcode.
Please enter a valid country.
Please select a valid state.
Please enter a valid address.
Please enter a valid address.
Please enter a valid address.
Please enter a valid suburb.
Please enter a valid postcode.
Please enter a valid country.
Please select a valid state.

Professional Details

Please select a valid nature.

Survey

Authorisation

Please complete this recaptcha.