AGAPÈ Wellness Advocacy
Application form
Please complete and submit to Apply. All required information will be emailed to you after submission and Agape will be in contact with you regarding your advocacy application within 2 weeks.
Please complete all required information to ensure a positive result for your application.
Your Name
*
First Name
Last Name
Business Name
Business ABN
Your role within the business
Business Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Why have you decided to Apply?
Please provide your media platform links
Webpage, Facebook, Instagram, LinkdIn
Please upload a Docx File containing a basic overview of the business.
Browse Files
Drag and drop files here
Choose a file
Include sections like - About Us, Locations, Type of Industry, Employee numbers and what you are hoping to gain from Agape.
Cancel
of
Select your Required Membership
*
prev
next
( X )
Standard Membership
Standard Base Advocacy Membership
$
499.00
AUD
Full Year starting July
Half Year starting January
Item subtotal:
$
0.00
AUD
Premium Membership
Premium Advocacy Membership
$
699.00
AUD
Full Year starting July
Half Year starting January
Item subtotal:
$
0.00
AUD
Gold Membership
Gold Advocacy Membership
$
999.00
AUD
Full Year starting July
Half Year Starting January
Item subtotal:
$
0.00
AUD
Card Authorisation - You will not be charged until your application has been approved
Register Now
Should be Empty: