Application For Membership

Application For Membership
Safety Partner Benefits
Application Information
Please briefly detail your association with the Road Transport Industry:
Why are you applying to join TRANSAFE WA? What do you hope to get from membership?
(eg. advocacy, events, safety and compliance resources, networks, safer industry, improvements to the status of truck-drivers)
What can you contribute to TRANSAFE WA?
What type of membership are you looking for?

Individual or Owner/Driver ($100 inc. GST)Safety Supporter - For Businesses With Less Than 10 Employees ($500 inc. GST)
Name

First NameLast Name
Company Name
Title
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Total Annual Fee:
Renewable Annually 12 Months From the Joining Date
Is there a current member of TRANSAFE WA that could provide a reference for you? If yes, please provide their name.
Safety Supporter Membership Entitles Your Collegues to Membership Benefits
Fleet and association company applicants, please list other key contacts at your organisation who we should also correspond with:*
Disclaimers and Signature
Membership is conditional upon acceptance by Transafe.com Inc’s Committee of Management as outlined in the Rules of the Association. I/we agree to be bound by the Rules of the Association, Transafe.com Inc trading as Transafe WA. Any personal information disclosed to us by you via this form or other means will be processed in accordance with our Privacy Policy. (Refer to www.transafewa.com.au for copies of the Transafe.com Inc Rules of Association and Privacy Policy).
Signature

Clear
Date

MonthDayYear
Date
Office Use Only
Membership Proposed / Approved By:
Date

MonthDayYear
Date
Should be Empty:

Application For Membership

Application Information

Safety Supporter Membership Entitles Your Collegues to Membership Benefits

Disclaimers and Signature

Office Use Only