Membership Application Form

= Required field

Organisation Details
Address
Name of Organisation:
ABN:
Number of Staff in Metropolitan Adelaide South Australia:
Street Address:
City:
Postcode:
Postal Address
Postal Address:	same as above
Postal Address:
City:
Postcode:
Contact
Phone:
Fax:
Website:

Direct Membership Contact
Name:
Job Title:
Direct Phone:
Mobile No:
Email:
Create a Password:
Voting Rights	assign to primary contact person

Second Contact Person (If applicable)
Name:
Job Title:
Direct Phone:
Mobile No:
Email:
Create a Password:
Voting Rights	assign to secondary contact person

To assist TIA to distribute pertinent information regarding membership benefits to your staff we ask for an appropriate contact such as;

HR / Administration Person (If applicable)
Name:
Job Title:
Direct Phone:
Mobile No:
Email:
Create a Password:

I agree to abide by the Terms & Conditions. Should I wish to resign my membership, I will do so in writing prior to June 30 of the current membership year.