Membership Application

* Name of Company

* Contact Person First Name

* Contact Person Last Name

* Your Position within the Company

* Email

* Contact Number

* Address

Invoice address is same as address listed above

If address for invoice is different, please enter invoice address below

* Industry the Company is operating in

Year the Company was Founded

Approx. turnover in AUD

* I am/We are interested in a membership

Corporate Member

Cluster Member - Energy

Cluster Member - Health and Life Sciences

Cluster Member - Mining and Resources

Platinum Partner

* The Company is a...

Rising Star (founded in the last three years; subsidiaries excempt)

Mittelstand Hero (annual turnover of less than $50 million))

Global Champion (annual turnover more than $50 million))

Your Company's Logo

* Disclaimer

I hereby consent to the processing of my personal data provided in this form for the purpose of contacting me and attending to my enquiry. My personal data will not be forwarded to third parties. I am aware that the consent is given voluntarily and can be withdrawn at any time, as provided in the Privacy Policy. * Captcha

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