Eiag membership form

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Eiag membership form

  1. 1. EIAG Membership Form (This is a Tax Invoice) (Please Print)Annual Fees (GST Inclusive)Membership benefits – refer to Page 3 item Action Plan (the benefits ofMembership) Corporate Membership $15,000 Associate Membership $1,800 Individual Membership $480 Donation (no GST) (Amount)$....................Organization: ……………………………………………..Mailing Address: …………………………………………………………………………………….………….…………………………………………………….. P/C ………………….Nominated Representative: ……………………………………………………………….Title: …………………………………………Contact details;Phone:……. - ……………………..Fax: …….. - ……………………….Mobile: …………………………….Email: ………………………………………………………………..Signature: …………………………………………………. Date …………………………..Please forward payment by cheque (with this form) made out to the Energy IndustryAdvisory Group or EIAG and mail your membership/donation to; The EIAG Locked Bag 1 The Patch Victoria 3792 Australia The EIAG Secretariat is managed on behalf of the EIAG by Arrina Pty Ltd (ABN 66107123258 & ACN 007416168) Phone: +61-3-97521300 Fax: +61-3-97521400 Email: aone@ozemail.com.au

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