NULCA Membership Application Form

 
For Due date:  July 1st
   
Company name:
Representative's name:
Representative's position:
Street Address:
Suburb:
State:
Postcode:
Postal Address:
Suburb:
State:
Postcode:
Business phone:
Fax:
Mobile:
Email address:
Website http://
   
SERVICES OFFERED:  Vacuum excavation
   Utility location or survey
   Cable faults
   Camera
   G.P.R.
   Leak location
   Industry supplier
   Civil Works/Infrastructure
   Training Organisation
MEMBERSHIP TYPE: Fees are in Australian Dollars annually
   Tier I - Locaters: $375
  Tier II - Training Authorities: $500
  Tier III - Manufacturers, Utilities/Gas/Water/Electric/
         Telecommunication, Service Providers: $500
  NOTE: New members joining fee:  Add $50.00 (one-off)
   
TELSTRA ACCREDITED?  Yes     Number:
 No
   
Why did you join NULCA?
   

PAYMENT DETAILS

 I will send you a cheque or money order (details below)
 I will transfer the money via EFT/Internet bank transfer (details below)
 I would like to pay by credit card. Please send me an invoice

Cheques and money orders should be made payable to "NULCA Australia Inc", and forwarded to:

PO Box 237
Hallam
Victoria 3803

EFT (Internet banking transfer) details:

Bank:  Westpac
BSB:    033341
Account name: NULCA
Account number: 231377
 
AUTHORITY TO DISPLAY DETAILS ON NULCA WEBSITE
 I authorise my company's details to be displayed on the NULCA website member list