Online Application

Your Given Name*

Your Surname*

Male Female 

Date of Birth*

Postal Address*

Suburb*

State
- Select -ACTNSWNTQLDSATASVICWA

Postcode*

Country

Mobile Phone*

Home Phone

Your Email*

Employer*
- Select -Virgin AustraliaVARATigerair

Employment*
- Select -Full Time 100%Part Time 75%Part Time 50%RORO

Base*
- Select -BNEMELPERSYDCBR

Fleet*
- Select -B737B777EjetA330A320ATR72F50F100

Rank*
- Select -CaptainFirst OfficerSecond Officer

Long Haul Only - Salary Level
- Select -Level 1Level 2Level 3Level 4Level 5Level 6Level 7Level 8

VARA Only - Year of Service
- Select -Year 1Year 2Year 3Year 4Year 5Year 6Year 7Year 8Year 9Year 10

Licence*
 ATPL CPL

Staff Number*

Referring Member - a current VIPA member who referred you to VIPA

VIPA Loss of Licence Fund - VLF*
I understand that to join the VLF I will need to complete a separate VLF Application Form and Health Questionnaire, which will be sent to me to complete and return before protection is offered.
 YES I would like to join VLF NO I decline protection

Payment*
Membership fees can be paid annually in full or by a regular direct debit. You will be emailed an invoice for pro rata annual payment or a direct debit invoice, for your records. Direct debits are managed by Ezidebit who charge a service fee. An electronic direct debit authority will be emailed to you to set up the direct debit.
- Select -Invoiced AnnuallyDirect Debit Monthly - 1st of each monthDirect Debit Quarterly - 15 Jul, Oct, Jan and AprDirect Debit 4weekly - coincide with Virgin O&A pays

By clicking Submit you indicate you have accepted the Terms and Conditions below:

1. I am employed as a pilot, on airline services within or extending beyond Australia, by Virgin Australia Group or any subsidiary related body corporate or associated entities, its successors, transmittee or assignee.

2. I agree to abide by the rules of VIPA (the “rules”) as amended from time to time.

3. I understand that I remain a member of VIPA until I revoke my membership in writing in accordance with the rules and with the Fair Work Act 2009.

4. I agree to pay annual subscription fees in accordance with the rules and that the annual subscription fee of VIPA is 0.9% (+ GST) of my annual gross salary as amended from time to time.

5. I have read the information supplied relating to financial obligations of membership and the circumstance and manner in which I may resign my membership.

6. I understand that my initial invoice will include a $15.00 (+ GST) admission fee.