Charter Fishing Vessel Division

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					 Application for Membership
 Please complete and return this form to:
 Marine Queensland
 PO Box 3305
 Tingapla DC QLD 4172
 (T) 07 3390 4657 (F) 07 3390 4962 (E) info@marineqld.com.au

 I/We the undersigned hereby apply for membership of Marine Queensland.

BUSINESS DETAILS

Company/Business Name:

Office Address:                                                                                                                           Postcode:

Postal Address:                                                                                                                           Postcode:

ABN:                                                                         Phone:                                                       Fax:

Mobile:                                                                      Email:

Website:

Date of Commencement of Trading: . . . . / . . . . . / . . . . .                                                                           No of Employees:


Public Liability Insurance?             (If “yes” please attach a copy to your application)
                                                                                                                                          Yes     □           No    □
DIRECTORS’ NAMES & ADDRESSES

Name:                                                                                                                                     Position:

Address:

Name:                                                                                                                                     Position:

Address

Are any of the Directors or Principals currently involved in any other Company or
Business?                                                                                                                                 Yes     □           No    □
If yes, please provide details




DECLARATION
I/We declare that the information presented on this application form is true and correct.
If accepted as a member of Marine Queensland I/we hereby agree to be bound by the Memorandum and Articles of Association of Marine Queensland, and by any amendments made thereto,
and to pay any annual subscription fees or levies as the Association shall from time to time determine.
I/We also agree to support the aims and objectives of the Association and to conform/abide by its Rules and Code of Ethics.
I/we understand that the submission of my/our cheque does not mean acceptance or any other entitlement of membership of Marine Queensland, and until a decision is relayed to me/us in
writing, I/we are not entitled to use the Association logo or in any way indicate that I/we are a member of Marine Queensland.



Signed:



Date:

                                                                                                                                                                  Marine Queensland ACN 009 930 741
                                                                                                                            Building 3, Level 2, Gateway Office Park, 747 Lytton Rd Murarrrie QLD 4172
                                                                                                                                                                  PO Box 3305, Tingalpa DC QLD 4173
                                                                                                       T [61 7] 3390 4567 ● F [61 7] 3390 4962 ● E info@marineqld.com.au ● W www.marineqld.com.au
      Membership Application Form (cont/d)
      Page 2




2010 MEMBERSHIP FEES

              Application Fee          (New Members Once Off Administration Fee inclusive of GST)                            $110.00

              Membership Fee             (inclusive of GST)                                                                  $495.00


PAYMENT DETAILS – A tax invoice will be issued upon receipt of payment

□      CHEQUE            (made payable to Marine Queensland )




□      CREDIT CARD                  (please note Credit Card payments will incur a 1% administration fee surcharge )              □ MasterCard                           □      Visa

Credit Card No:
Cardholder’s Name:
Expiry Date:                                                                                          Total Amount:

Signed:


□      ELECTRONIC FUNDS TRANSFER
        Account Name: BOATING INDUSTRY ASSOCIATION OF QUEENSLAND T/A MARINE QUEENSLAND
        Bank: National Australia Bank Branch: CREEK STREET, BRISBANE          BSB: 084 004                                                   ACCOUNT NO: 508391874


□      MONTHLY DIRECT DEBIT - $55.45/month (inc. GST)

Please nominate an email address to receive the Direct Debit Request and Service Agreement which are to be completed to activate

your direct debit payments:_______________________________________________

Remittances Email: info@marineqld.com.au                                                              Remittances Fax: 07 3390 4962
Should your application be unsuccessful for any reason, the membership fee will be returned to you.

Application for membership is subject to approval and acceptance by the Marine Queensland Board. The Board reserves the right to request further information from all necessary sources in the consideration of this application.




OFFICE USE ONLY
CONFIRMED:

DATE:

TERMS & CONDITIONS
By completing and submitting this form you may be subject to a Business History Check at the discretion of Marine Queensland and its Executive Committee.

PRIVACY
Please note that the information you provide on this form is “personal information” pursuant to the Privacy Act 1988 (“the Act”). This information is being collected for the purposes of
processing your application, to provide you with membership services and to keep you informed of upcoming industry events. The intended recipient of this voluntarily provided information
will be Marine Queensland and its service providers. You have the right of access to and alteration of personal information concerning yourself held by Marine Queensland in accordance with
the Act. The information is being collected by Marine Queensland and will be held by Marine Queensland.




                                                                                                                                                                                      Marine Queensland ACN 009 930 741
                                                                                                                                                Building 3, Level 2, Gateway Office Park, 747 Lytton Rd Murarrrie QLD 4172
                                                                                                                                                                                      PO Box 3305, Tingalpa DC QLD 4173
                                                                                                                           T [61 7] 3390 4567 ● F [61 7] 3390 4962 ● E info@marineqld.com.au ● W www.marineqld.com.au

				
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Description: Charter Fishing Vessel Division