Membership Sign Up | KBA Business

KBA Membership Sign Up Form

2023/2024
Your business details
Business Name*
Industry*
Your contact details
Name*

First NameLast Name
Email*
Mobile Number*
Please enter a valid phone number.
Business Number

Area CodePhone Number
Website
If applicable
Business Address*

Street Address or Postal Address (For Home Based / Online Businesses)

Street Address Line 2

CityState

Zip Code
Social Media Details
Facebook Page
If applicable
Instagram Page
If applicable
Payment Details & Agreement
I wish for this business to become a participating and active member of the Korumburra Business Association. In the event of my business being accepted as a member, I agree to support the purposes of the Korumburra Business Association Inc. and to comply with the Association's Rules.*

I Agree
View the KBA Association Rules
View the Association Rules
Date*

DayMonthYear
Date
Signature

Clear
PAYMENT DETAILS
Membership Fee $60.00
Electronic funds transfer/bank deposit

BSB 633-000 Account No: 120 711 395
Should be Empty:

KBA Membership Sign Up Form