Membership Application Form

To The Executive Committee: -

You may either download a membership form or simply complete the form below.

Business Name (in full):	*
First Name:	*
Surname:	*
Business Type:
Business Address:
Postal Address:	As above
Email:	*
Phone:
Fax:
Mobile:
Number of Employees:	Full Time: Part Time:
Corresponence Via:	Mail Fax Email
	*Required

Please Note:
The Subscription Fee is required at the time you lodge your application. (Tax deductable).

Membership Fees $ 200.00 + G.S.T. $ 20.00 = $220.00
Six Months or less - $100.00 + G.S.T. $ 10.00 = $110.00
Please forward payment to: PO Box 611 • Busselton • WA 6280