APPLICATION FOR MEMBERSHIP
OF THE
LIVESTOCK AND RURAL TRANSPORT ASSOCIATION OF WESTERN AUSTRALIA (INC)
ABN 19 133 586 109
_________________________________________________________________________________________
(state trading name of person, firm or company)
hereby applies for admission to
THE LIVESTOCK AND RURAL TRANSPORT ASSOCIATION
OF WESTERN AUSTRALIA (INC)
as a ________________________________________________________________member
(state either Corporate, Owner Driver or Associate)
I/We (cross whichever does not apply) agree to be bound by the Rules of the Association.
I/We also apply for driver employees whose details appear below to be admitted as Driver Members of
the Association and agree that they shall also be bound by the Rules of the Association.
Note: do not list owner as a driver member; he/she automatically qualifies for membership.
My/our annual subscription for $_______________ is attached.
Name :_______________________________________
CORPORATE MEMBERSHIP
Signature:______________________________________
Mobile: ____________________
Number of Prime Movers
1
$286.00
2
$346.50
3
$407.00
4
$473.00
5
$533.50
6
$605.00
Email:
OWNER DRIVER
$286.00
ASSOCIATE (company)
$286.00
(individual)
$114.50
Postal Address: _________________________________
_______________________________________________
Telephone:_________________ Fax: _______________
_______________________________________
No of Trucks: _________ No. of Tippers: ___________
No. of Cattle Crates: _____ No of Sheep Crates: _______
DRIVER’S NAMES :
DRIVER MEMBER
$33.00
EFT Payment Details: please use
company name as reference.
___________________________________________________________
_
__________________________________________________________
Bank:
NAB
________________________________
BSB:
086
131 Acc: 16-915-9922
_________________
Any personal information disclosed to us by you, upon filling in the enclosed membership
form or by other means,
________________________________
will be processed by us in accordance with our Privacy Policy. The Privacy Policy_________________
may be obtained from the
LRTAWA office or the website www.lrtawa.org.au. Please tick if you wish to receive a copy of the Policy.
________________________________
OFFICE USE ONLY:
MEMBER NUMBER: _______________________
_________________
From time to time the Association is asked
to provide contact details of members for
sponsors specials or other communication
from industry associates.
Please return to Livestock and Rural Transport Association of Western Australia (Inc), 277-279 Great Eastern
Highway, Belmont 6104. Telephone 08 94783655; Fax 08 92777311; www.lrtawa.org.au.
If you do not want your details provided,
please tick here.