APPLICATION FORM

I wish to apply for membership of the Malaga and Districts Business Association, and agree to abide by the constitution and rules of the Association. The current joining fee is $302.50 inc GST. Second year $192.50 inc GST.

Please fill in the information on the form, then use the print button on your browser to print it. Then post with your cheque or fax if paying by credit card.

Mandatory Information Required:
Contact Name
Position in Business
Name of Business
Business Address
Postal Address
Business Phone
Fax
Email
Our preferred method of communication is by email. Please tick box if you do not wish to be contacted via email		No emails
Nature of Business
ABN
Optional Information:
Reason for joining?
How long has your business been operating?
Is your base in Malaga?	Yes	No
Percentage of business conducted in Malaga?
Payment Information:
Paying by cheque	Yes	No
Paying by credit card	Mastercard	Visa
Card Number
Name on Card
Expiry Date

Signature__________________________________________________

Date ________________________

Please faxback to the Executive Officer on 9248 2526
or
Post with your cheque to

Malaga & Districts Business Association
PO Box 3022
Malaga DC WA 6945