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.