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
Should be Empty:

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