Membership application

Membership Application

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Membership Team

Electrical Contractors Licence Details

State*

Electrical Contractors Licence Number*

Electrical Contractors Licence Expiry*

Licence Application in Progress

Main Contact Details

Title

First Name *

Last Name *

Date of Birth *

Gender *

Job Title

Email *

Confirm Email *

Main Contact is a Women in Contracting Representative

Is the address an Australian address?

Street Address *

City *

State *

Postcode *

Country *

Postal Address same as Street Address

Is the address an Australian address?

Postal Address *

City *

State *

Postcode *

Country *

Business Phone *

Preferred (Business Phone)

Mobile Number *

Preferred (Mobile Phone)

Equity Group

Indigenous*

Culturally & Linguistically Diverse*

Disability*

Membership Information

Total Full-time Staff (excluding Office & Part-time staff)*

Office & Part-time Staff (excluded for invoicing)*

Payment frequency for your subscription*

Price (inc GST)

ME Safety - optional

Add ME Safety Program

Other Representatives (Multiselect)

Payment

Name on Card

Card Number*

Expiry*

CVC*