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Gold Card Membership Subscription
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Company
Partnership
Sole Trader
ABN*
GST Registered*
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Company / Registered Name
Business Name*
Phone
Fax
Primary Business Location
Address*
Address 2
City*
State*
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
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Victoria
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Postcode*
Country
Australia
Mailing Address
Address
Address 2
City
State
Postcode
Director / Proprietor
First Name*
Last Name*
Position*
Date of Birth*
Driver Licence No*
Mobile*
For business use*
Yes
No
Home Phone No
Home Address*
Additional Director / Proprietor
Full Name
Position
Driver Licence No
Mobile
Home Phone No
Home Address
Other Details
Email*
Contact Person*
Website
Source of Contact*
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Payment Information
Joining Fee
$330.00 for the first 1 month (incl. GST)
Admin Fee
$16.50 for every 1 month (incl. GST)
Payment Method
Paypal
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