Membership Application

Business Name *

Address *

Post Code *

PO Box

Membership Level *

Primary Contact

First Name *

Last Name *

Email *

Phone Number *

Newsletter Subscription

(Up to 2 for Standard Membership, 4 for Principal Membership)

Representative 1

Name

Phone Number

Representative 2

Name

Phone Number

EKCCI Website Directory Listing

Member businesses have access to promote their business on our website. We are in the process of upgrading our website www.ekcci.com.au. To take full advantage of this opportunity please review your page and provide by email to [email protected] the details and logos you would like added. We suggest you provide your contact details, a description of your business and the services offered, website link etc.

Declaration

On behalf of the above mentioned business/organisation & representatives, I agree to the Conditions of Membership as presented to me: EKCCI are committed to handling your contact information in accordance with Commonwealth and State Privacy Laws. To ensure our practices comply; signing this application for membership acknowledges you have agreed to participate in the following;

I agree to receive newsletters, event invitations and special offers from EKCCI
I agree to have my business/organisation contact information included on the EKCCI Website ‐ Directories Member listing

(You may opt out of any of these services at any time by contacting EKCCI directly.)

Yes, I Agree *

Yes, I Agree

Name

Image Courtesy of Image Courtesy of Penney Hayley

Membership Application

Primary Contact

Newsletter Subscription

Representative 1

Representative 2

Representative 3

Representative 4

EKCCI Website Directory Listing

Declaration