WHS Foundation Membership Company Application

1

Membership Type* This field is required. Prices include GST

Corporate Plus $895Corporate $495

2

Existing Member?* This field is required. Are you an existing member?

YESNO

3

Company Name* This field is required. Please provide your company name.

4

Use Existing Details?* This field is required. Would you like all company and contact details to remain as they are on our system?

YESNO

5

Company Details This membership covers entitles falling under this ABN. Please attach a list of any branches you wish to include in the membership that fall under this ABN. Subsidiaries under a separate ABN required to apply for Membership in their own right.

Company Name

ABN

Address

Suburb

Postcode

Email

Phone

6

Primary Contacts For Membership information and updates

Name

Position

Email

Phone

7

Additional Contacts 1 (Optional) Such as Training Coordinator or Finance

Name

Position

Email

Phone

8

Additional Contacts 2 (Optional) Such as Training Coordinator or Finance

Name

Position

Email

Phone

9

Payment If you have PO, please enter the PO number. If you want a quote or to pay by Credit Card, simply click 'NEXT'.

10

Declaration* This field is required. I understand that WHS Foundation Membership is conditional upon acceptance by WHS Foundation’s Board of Directors. I request that this application be submitted to the WHS Foundation Board of Directors for approval. I understand that WHS Foundation will provide membership benefits upon receipt of the application and payment. I understand that as a WHS Foundation member, I am entitled to voting rights at the Annual General Meeting.

First Name

Last Name

11

Signature* This field is required.

Clear