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
*
Format: (00) 0000-0000.
ABN
*
Masthead Applying for Membership
*
Name of Publication
Frequency of Publication
*
Weekly, Fortnightly, Monthly
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 state’s Press Association. Please tick box of membership you are applying for
*
CPA Membership - $400.00 +GST
Victorian Country Press Association - $1,000.00 +GST
TOTAL MEMBERSHIP FEES
*
Total $ of all memberships
Signed
Date
/
Month
/
Day
Year
Date
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