WQ TMA Membership application form
Business Name
*
Trading Name
(if different from above)
Industry Sector
*
(e.g. marine, banking, commercial)
Number of employees
*
Company Postal address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Physical address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone Number
*
-
Area Code
Phone Number
Primary Contact person
Name
*
First Name
Last Name
Job Tittle:
*
Direct Dial
-
Area Code
Phone Number
Cellphone Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Secondary contact person
this will only be activated if primary contact person is uncontactable
Name
First Name
Last Name
Job Tittle:
Direct Dial
-
Area Code
Phone Number
Cellphone Number
-
Area Code
Phone Number
E-mail
example@example.com
What is your business website address?
A link will be created to this address on the WQ TMA website.
Information & Declaration
Membership invoices are usually sent out in October and cover the subsequent 12 month period. Membership fees paid at other times will be due again the following October. Membership fees are non refundable. By signing and submitting this form you are declaring that the information given in this application is correct, and you agree to pay the correct membership fee. As an Incorporated Society, Wynyard Quarter Transport Management Association is obliged to keep an accurate and up to date membership list. Your information will not be shared with any other parties. If any of the details you have given here change, please notify us.
Your Name
*
First Name
Last Name
Date
*
-
Day
-
Month
Year
Date
Signature
*
Clear
Submit
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