CPA New Member Details (NSW)

CPA New Member Details

Please fill in all blank spaces for ease of processing your application
MEMBER NAME AND CONTACT DETAILS
Company Name *
Registered Address *
City *
State *
Postcode *
Contact Name *
Accounts Email *
example@example.com
Phone *
ABN *
Masthead Applying for Membership *
Name of Publication
Publication Day *
Monday, Tuesday. Wednesday, Thursday etc
Frequency of Publication *
Weekly, Fortnightly, Monthly
Distribution Number/ Circulation *
Book Size *
eg how many pages
First Published *
Date of first edition
Masthead Website *
www.countrypressaustralia.com.au or Facebook address
BANKING DETAILS
Bank *
BSB *
Account No *
MEMBERSHIP

A requirement of CPA membership is that you also need to be a member of your states Press Association Please tick box of membership you are applying for
*

CPA Membership - $400.00 +GST NSW Country Press Association - $400.00 (Existing CPNSW Members $500 + GST) Regional Media Connect Associate Member - $50.00 +GST
TOTAL MEMBERSHIP FEES:
Total $ of all memberships
Signed

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Best Contact Number
Please enter a valid phone number.
Date

Month Day Year
Date
Should be Empty:

CPA New Member Details