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Associate Membership Program

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Application Form to become an Associate Member

To apply to become an AMMA Associate Member, please complete the form below and submit.

You will then receive instructions to arrange payment by EFT, cheque or credit card.

If you wish to pay by credit card today you can then proceed to AMMA's secure online payment area. AMMA accepts Mastercard, Visa, Diner's Club and American Express. Please note that credit card payments incur a 2.5% surcharge.

You will also be asked to accept the terms and conditions of the Associate Membership Program, to view these please click here.

Company and Contact Details
Date	Set
Company Name	*
Parent Company Name	*
ABN	*
Registered Street Address	*
City	*
State	*
Postcode	*
Postal Address (if different)
City
State
Postcode
Website	*
Company Billing Address (if different to above)
Company Director Names	*
Main Company Activity	*
Key Contact for Associate Membership
Name	*
Position	*
Phone	*
Fax	*
Email	*
Address (please indicate 'as above', or alternative if applicable)	*
Key Contact for Sales and Marketing (if different)
Name
Position
Phone
Fax
Email
Address (please indicate 'as above', or alternative if applicable)
CEO/Managing Director
Name	*
Position	*
Phone	*
Fax	*
Email	*
Address (please indicate 'as above', or alternative if applicable)	*
How did you find out about AMMA Associate Membership?
Please tick all which apply *	ColleagueAMMA EventPrevious ExhibitorOther PublicationPrevious Member
Please provide further details
Selection Criteria - Associate Members must be successfully checked against the following criteria
Please provide 1 SUPPLIER referee that you have worked with in the last 12 months
Please provide 1 CUSTOMER referee that you have provided products/services to in the last 12 months
Level of Membership
Please choose *	PlatinumGoldSilver plusSilver
Membership Fees
Please read the following	The Associate Membership Program is conducted on a financial year calendar for Silver Plus and Silver members. The Membership Fee Scale for Silver Plus and Sliver members is pro rata dependent on which month a member joins, however there is a minimum of 6 months' membership fee for any member joing December - June in that financial year.
Please select the appropriate month for your application
Silver Plus Membership Only	Jul $8500Sep $7500Nov $6500Dec - Jun $6000 Aug $8000Oct $7000
Silver Membership Only	Jul $6000Sep $5000Nov $4000Dec - Jun $3500 Aug $5500Oct $4500
Payment Options
Please indicate how you intend to pay *	EFTChequeCredit Card - NB there is a 2.5% surcharge
Please note the following	A tax invoice will be generated on approval of this application and receipt of payment. All amounts listed are in $AUS and include 10% GST. On clicking SUBMIT, further details will be provided to enable payment by either EFT, Cheque or Credit Card to be made. Those wishing to make a Credit Card payment will be able to proceed to AMMA's secure online payment facility. Please note however there is a 2.5% surcharge for payments made by Credit Card.
Privacy Information
Please note the following	AMMA acknowledges and respects the privacy of its members. All information provided on this form is subject to the AMMA Privacy Policy, available on request from AMMA on 03 9614 4777. You have the right of access to and alteration of personal information concerning yourself in accordance with the Privacy Act. The information is being collected by AMMA and will be held by AMMA. Please direct any enquiries you may have in relation to this matter to our Privacy Officer, Naomi Ford on 08 8212 0585. AMMA is a not for profit organisation. All money generated from membership is recycled back into the sustainability of the resources and energy sector.
I acknowledge and agree to the AMMA Associate Membership Program Terms and Conditions *	Yes

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