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 :_______________________________________
Signature:______________________________________
Postal Address: _________________________________
_______________________________________________
Telephone:_________________ Fax: _______________
Mobile: ____________________
Email:
_______________________________________
No of Trucks: _________ No. of Tippers: ___________
No. of Cattle Crates: _____ No of Sheep Crates: _______
Driver’s
Names
DRIVER’S
NAMES :
CORPORATE MEMBERSHIP
Number of Prime Movers
1
2
3
4
5
6
$278.01
$341.19
$404.37
$467.54
$530.72
$593.90
OWNER DRIVER
$278.01
ASSOCIATE (company)
$278.01
(individual)
$111.23
DRIVER MEMBER
$31.76
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 If(Inc),
277-279
Great
you do
not want
your details provided,
Eastern Highway, Belmont 6104. Telephone 08 94783655; Fax 08 92777311;please
www.lrtawa.org.au.
tick here.
National sponsors support the Association through commission based schemes. The proceeds of
these arrangements help provide services for members. The following information will help the
Association ensure it receives the benefit of commissions:
1. Do you use BP Australia?
Yes.
Please provide your BP Fleet Number - __ __ __ __ __ __ __ __ (middle eight digits of BP Plus
card)
No, but please send me further details
2. Do you use Beaurepaires?
Yes.
Please provide your account number - :_________________________________________
The number is besides the word “Customer” on your tax invoice.
No, but please send me further details.
Name of your Company:
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.