Membership Form
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Required
Please enter your details below:
*
Name:
*Title :
*Company:
*Address:
*Suburb/Town:
*State
:
*Postcode :
Country
:
*Phone:
*Fax:
*E-mail:
Comments:
Type of Organization:
Agriculture:
Mining:
Earth Moving:
Packaging:
Government:
Service:
Manufacturing:
Transport:
Marine:
Other (Please Specify)
Main Area of Responsibility:
Administration:
Production:
Engineering:
Purchasing:
General Management:
Sales/Marketing:
Maintenance:
Servicing:
Other (Please Specify)
Subscriptions:
(Renewals from March 1, 2010 to Feb 28, 2011)
Price
GST
Total
Individual
$90.00
$9.00
$99.00
Corporate Membership*
(Four Nominees)
$400.00
$40.00
$440.00
Additional Nominees:
$90.00
$9.00
$99.00
2 Additional Nominees
$180.00
$18.00
$198.00
3 Additional Nominees
$270.00
$27.00
$297.00
4 Additional Nominees
$360.00
$36.00
$396.00
Total:
Details of Additional Nominees:Person 1
Name:
Company:
Address:
Town/Suburb:
State:
VIC
NSW
QLD
ACT
SA
TAS
NT
WA
Postcode:
Country:
Phone:
Fax:
Details of Additional Nominees:Person 2
Name:
Company:
Address:
Town/Suburb:
State:
VIC
NSW
QLD
ACT
SA
TAS
NT
WA
Postcode:
Country:
Phone:
Fax:
Details of Additional Nominees: Person 3
Name:
Company:
Address:
Town/Suburb:
State:
VIC
NSW
QLD
ACT
SA
TAS
NT
WA
Postcode:
Country:
Phone:
Fax:
Details of Additional Nominees: Person 4
Name:
Company:
Address:
Town/Suburb:
State:
VIC
NSW
QLD
ACT
SA
TAS
NT
WA
Postcode:
Country:
Phone:
Fax:
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