Membership Application Form

Membership Application Form

Please complete the following application details. If you have any problems and would like assistance, please do not hesitate to contact ATUG membership on (02) 9495 8904 or email@atug.org.au

Click here for downloadable version & fax back to (02) 9419 3889

Name of Organisation*
Address *
Telephone*		Facsimile*
Mobile (work related)		Email Address*
Type of Industry *		Website
Preferred method of contact	Email Fax

Please nominate number of representatives as per your category. The first representative will be assigned voting rights (if any).
Representative 1
Name*
Position*
Address *
Postcode*
Tel*		Fax*
Mobile (work related)		Email*

Representative 2
Name
Position
Address
Postcode
Tel		Fax
Mobile (work related)		Email

Representative 3
Name
Position
Address
Postcode
Tel		Fax
Mobile (work related)		Email

Representative 4
Name
Position
Address
Postcode
Tel		Fax
Mobile (work related)		Email

Card Holder Position

Date

Method of payment Mastercard Visa AMEX Cheque Diners Card

Credit Card details Expiry date

Please contact our Membership Co-ordinator on 02 9495 8904 for your membership fee.

Your annual membership fee	*
GST
Total