BNCC Membership Application

Your Details

Title CR DR MISS MR MRS MS
First Name *	Last Name *
Position	Email Address *

Company Details

Company Name *	Trading Name *
ABN Number *	Web Address
Industry * -- Please select -- Banking and Finance Business Services Government Manufacturing Retail Trades Wholesale Personal Services Property Travel IT Telecommunications Hospitality Other

Contact Details

Site Address	Postal Address Same as Site Address
Site Address	Postal Address *
Suburb	Suburb *
State	State *
Postcode	Postcode *
AUSTRALIA	AUSTRALIA
Phone Number *	Mobile Number
Fax Number

Marketing Feedback

How did you hear about the BNCC? * -- Please select -- BNCC Member BNCC Website BNCC Event Invitation Quest Newspapers Chamber of Commerce & Industry Qld (CCIQ) Kedron-Wavell Services Club Racecourse Road Precinct Membership Officer Other

If Other, please specify:

Please tick here to spend a few minutes providing us with some further information to help us ensure we are keeping up-to-date with our members’ expectations

What services and benefits of membership are you particularly interested in? Monthly meetings Workshop Sessions or Seminars Networking Functions Women’s Networking Functions Trade Shows or Fairs Breakfasts with Guest or Member Speakers Special Guest Business Seminars Quarterly Economics Updates Advertising or Sponsorship Opportunities Platform to lobby on local issues Chamber newsletters and updates Other

Other - explain

Are you interested in becoming a member of the BNCC Executive? Yes   No

Are you interested in becoming a member of a BNCC Subcommittee? Yes   No

The Hub – Women’s Networking division Gateway Chapter Newsletter Website Membership

Membership Details

What Membership Level do you need? Affiliate Member Sole or Joint Trader (1 – 2 Employees) Small Business (3 – 20 Employees) Medium/Large Business (20+ Employees) Not for Profit Organisation

To be eligible for Affiliate Membership you must be a representative of local, state or federal government.

Your level of Membership is .
The total cost of your membership is
This includes annual membership fee and a one off $30 joining fee (no joining fee for Not for Profit Organisations).

Payment Details

Credit Card
Direct Deposit (please enter Word Verification below and click submit to complete)
Cheque (please enter Word Verification below and click submit to complete)

Name on Card *	Card Number *
Card Expiry * 01 02 03 04 05 06 07 08 09 10 11 12 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Card Type * Visa Master Card	CCV Number *

Submission

Please tick to confirm that you have read and agreed to our Privacy Statement *

Amount *

Enter word verification (case sensitive) in box below*

Cancellation Policy: Until your membership has been approved by the board and you have been issued with a Certificate and Member Pack, you may cancel and receive a full refund. However, once your membership has been approved, there is no refund available. If at any stage you feel you are not getting value for your membership, please contact one of the Executive Board Members so that we may work out the best way to remedy this.