ASSOCIATE MEMBERSHIP 2020

AMEC MEMBERSHIP 2020

ASSOCIATE MEMBER

Contact details

Company Name: *

ABN: *

Principal business activity: *

Postal Address: *

City/Suburb: *

State: *

New South Wales Victoria Queensland South Australia Western Australia Northern Territory Tasmania Australian Capital Territory

Postcode: *

Telephone: *

Web Address (URL):

Key Company Representative: *

Dr Mr Mrs Ms

Name

First Name Last Name

Position/Title: *

Email *

example@example.com

Mobile: *

Managing Director/CEO:

Position/ Title:

if the same as above, please ignore this field.

Managing Director/CEO Email:

example@example.com

Accounts Contact:

Accounts Contact Email:

example@example.com

Other Company Contacts

1. Name:

Position:

Email:

example@example.com

2. Name:

Position:

Email:

example@example.com

Subscriptions & Fees

Category	Fees (excl GST)	Fees (incl GST)
Level 1 (0-20 Employees in Australia)	$1,215	$1,336.50
Level 2 (21-100 Employees in Australia)	$2,855	$3,140.50
Level 3 (101+ Employees in Australia)	$3,935	$4,328.50

Please select the relevant category: *

Number of employees (including contractors) *

1-20 21-100 101-199 200+ 400+

Service provided *

Drilling Environmental Financial Geo & Lab services ICT Legal and Tenement Media & Communication Other

Reason for joining AMEC (Please check relevant box(es)): *

Advocacy/Lobbying Networking Access to Information Insurance Facility Conferences & Events Other Commercial Benefits Support the Industry

What other services could AMEC offer?

Privacy statement

In accordance with the data privacy act, AMEC does not disclose members contact details to third parties. The purpose of collecting contact information is to process membership and keep members up-to-date with policies, advocacy activities, networking events and general AMEC information.

If you do not wish to receive further information, please tick this box.

Signature

Clear

Date: *

Date

Method of payment (Please tick) *

EFT (Bank details will be sent on submission of form) Debit/Credit Card (Secure payment accepted below)

Secure Debit/Credit Card payments accepted below. If paying by EFT, please skip this section, and press "Submit".

Annual Subscriptions (Fees inclusive of GST)

Level 1 ( $ 1,336.50 AUD for each year )

0-20 Employees in Australia.

Level 2 ( $ 3,140.50 AUD for each year )

21-100 Employees in Australia.

Level 3 ( $ 4,328.50 AUD for each year )

101+ Employees in Australia.

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Billing Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Please verify that you are human *

Thank you!