Australian Cannabis Agency
Suite 2, Level 35, 360 Elizabeth Street, Melbourne, VIC, 3000 admin@cannabis.org.au www.cannabis.org.au (+61) 421283826
NEW MEMBER REGISTRATION FORM
Business
Company Name
ABN
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
How did you hear about us?
*
Please Select
Linkedin
Internet
referral
Other
What role do you currently play in the Australian Cannabis ecosystem?
Suggestions on how you want to be involved with the not-for-profit
Would you be interested in sponsoring or speaking at our next event?
*
Yes
No
Maybe
Membership Type
*
Individual ($150)
Start Up ($799)
Company ($2750)
Consent
*
Completion of this form and submission does not constitute acceptance of your application. Australia Cannabis Agency Ltd reserves the right to review and where appropriate, reject applications at their discretion. Your membership commences upon receipt of your membership fee. Your membership includes a cannabis.org.au newsletter subscription, upon your payment, you hereby consent to receive communications from us. You may unsubscribe at any time. Yes, I agree with above.
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