Membership Subscription Renewal Form

1
Membership Number(Quote on payment)
2
Trading Name
3
Company / Partnership Name
4
ABNPlease provide your registered ABN number
5
Business Address
Street Address
Street Address Line 2
City
Please Select
Please Select
New South Wales
Victoria
South Australia
Queensland
Northern Territory
Western Australia
Australian Capital Territory
State
Post Code
6
Business Postal Address
Street Address
Street Address Line 2
City
Please Select
Please Select
New South Wales
Victoria
South Australia
Queensland
Northern Territory
Western Australia
Australian Capital Territory
State
Post Code
7
Business Phone Number
Please enter a valid phone number.
8
Mobile Phone Number
Please enter a valid phone number.
9
Email
example@example.com
10
Website
www.example.com.au
11
Name
First Name
Last Name
12
Position
13
Private Address
Street Address
Street Address Line 2
City
Please Select
Please Select
New South Wales
Victoria
South Australia
Queensland
Northern Territory
Western Australia
Australian Capital Territory
State
Post Code
14
Private Phone Number
Please enter a valid phone number.
15
% Of Shares Held In Company
16
Name
First Name
Last Name
17
Position
18
Sole Trader Name
First Name
Last Name
19
Sole Trader Licence Number
20
Sole Trader Licence Expiry Date
Date
Day
Month
Year
21
Company / Partnership Name
22
Company / Partnership Licence Number
23
Company / Partnership Licence Expiry Date
Date
Day
Month
Year
24
Qualified Supervisor Name
First Name
Last Name
25
Qualified Supervisor Q/S Certification Number
26
Qualified Supervisor Q/S Certification Expiry Date
Date
Day
Month
Year
27
Category Member
P - Sole Proprietor and/or 1 Apprentice ($486.75 Inc GST)
P1 - Proprietor + 1 to 4 Employees ($612.00 Inc GST)
P5 - Proprietor + 5 to 10 Employees ($806.25 Inc GST)
P11 - Proprietor + 11 to 18 Employees ($1,593.75 Inc GST)
P19 - Proprietor + 19 to 25 Employees ($2,367.00 Inc GST)
P26 - Proprietor + 26 plus Employees ($3,210.00 Inc GST)
28
I'd like to pay via:
Direct Debit Existing Member – Continue with existing Direct Debit Agreement
Direct Debit New Member – Please print and complete the attached Direct Debit Request (DDR) for Membership and email to info@masterplumbers.com.au.
Cheque - Please send to PO Box 42 Lidcombe NSW 1825
EFTPOS - Please email info@masterplumbers.com.au
VISA - Please email info@masterplumbers.com.au
29
Direct Debit Request (DDR) for Membership formDirect Debit New Members ONLY
30
Signature
Clear
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