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Medium Business Membership Application
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Business Details
Business Name
*
ABN
*
Number of Employees
*
Physical Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Western Australia
New South Wales
Victoria
Queensland
South Australia
Tasmania
Australia Capital Territory
Northern Territory
State / Territory
Post Code
Postal Address (If different to above)
Address Line 1
Address Line 2
City
--- Select state ---
Western Australia
New South Wales
Victoria
Queensland
South Australia
Tasmania
Australia Capital Territory
Northern Territory
State / Territory
Post Code
Phone
*
Primary Contact
Name
*
Position in the business
*
Email
*
Phone
*
Email (accounts & invoicing) if different to above
Please provide a short description of the primary purpose of your business
*
Industry Type
*
Accounting, Banking and Financial Services
Administration and Office
Advertising
Aged Care and Support Work
Agriculture
Arts and Media
Community Services
Construction
Consulting
Early Childhood
Education and training
Engineering and Manufacturing
Government Agency
Healthcare and Medical
Hospitality
Human Resources and Recruitment
Indigenous Employment and Training
Indigenous Support Services
Information Technology
Legal Services
Marketing
Mining
Power, Utilities and Service Providers
Real Estate
Sole Trader/Contractor
Sport and Recreation
Tourism
Trades and Services
Transport and Logistics
Indigenous Owned
Not For Profit
Reciprocal Membership
Other
Newsletter Subscription
Representative 1
Name
*
Job Title
*
Email
*
Representative 2
Name
Job Title
Email
Representative 3
Name
Job Title
Email
Member Declaration
Declaration
*
Yes, I agree
*
I/We give my permission for this information to be included on the database and online directory.
I/We give permission to EKCCI to use and publish my photographs for promotional use.
I/We agree to abide by the Constitution and rules of the Chamber.
On behalf of the above-mentioned business/organisation & representatives, I/we agree to the conditions of Membership as presented to me.
EKCCI is committed to handling your contact information in accordance with Commonwealth and State Privacy Laws. To ensure our practices comply.
I/we agree to receive newsletters, event invitations and special offers from EKCCI
(You may opt out of any of these services at any time by contacting EKCCI directly.)
Tax Invoice
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