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Copyright
All items marked with are mandatory information.
 YOUR DETAILS
Applicant is (please select)
Applicant Name  
Applicant ABN  
Postal Address  
Post Code  
State  
Country   
Telephone  
Email   
 
 Contact person within Applicant's organisation
Contact's Name  
Contact's Position  
Telephone  
Mobile
Email   

 THE INSTITUTE'S PUBLICATION
What is title of the publication avaiilable from the institute that you want to use?   
Author of the Institute's Publication   
Date of the Institute's Publication
Calendar    
 
 YOUR PUBLICATION
What is the title of your publication?   
What type of publication is it? For example, paper based journal issued monthly, electronic publication distributed from website, etc.
How do you want to use the Institute's Publication and what is the intended market? Eg:
(a) re-publication in journal predominantly distributed to actuaries practising in UK; and
(b) as part of university course materials for approximately 30 masters students in NSW 		  
Sale price (if any) of your publication?     Price    
What are the predominant territories your application is distributed in? Eg, Asutralia only, worldwide.  
Approximately how many copies of your publication do you intend to print that will use the Institute's Publication?  
How long do you want to use the Institute's Publication do you for? Eg, 12 months, in perpetuity  
 
Other relevant information the Institute may need to know to assess your application