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Organisational Membership Application:

Note: Please check about your organisation's membership status. If already a member, you may wish to register your interest with QSMA for regular updates. info@qsma.org.au

Applicant 1 Details (*Denotes a compulsory field)

CONTACT NAME *

ROLE *

DEPARTMENT/ORGANISATION *

Applicant 2 Details

It is important that each organisation nominates 2 representatives to ensure continuity of information flow and participation in times of absence.

CONTACT NAME *

ROLE *

DEPARTMENT/ORGANISATION *

Department/Organisation Details

STREET ADDRESS *

POSTAL ADDRESS *

STATE/TERRITORY *

TOWN/SUBURB *

POSTCODE *

Applicants' Contact Details

TELEPHONE (APPLICANT 1) *	TELEPHONE (APPLICANT 2) *
FACSIMILE (APPLICANT 1)	FACSIMILE (APPLICANT 2)
EMAIL (APPLICANT 1) *	EMAIL (APPLICANT 2) *
http:// DEPARTMENT/ORGANISATION WEBSITE

I have read and agree to the terms and conditions. *

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Organisational Membership Application:

CONTACT NAME *

ROLE *

DEPARTMENT/ORGANISATION *

Applicant 2 Details

CONTACT NAME *

ROLE *

DEPARTMENT/ORGANISATION *

Department/Organisation Details

STREET ADDRESS *

POSTAL ADDRESS *

STATE/TERRITORY * Queensland New South Wales ACT Victoria Tasmania South Australia Western Australia Northern Territory

TOWN/SUBURB *

POSTCODE *

Applicants' Contact Details

TELEPHONE (APPLICANT 1) *

TELEPHONE (APPLICANT 2) *

FACSIMILE (APPLICANT 1)

FACSIMILE (APPLICANT 2)

EMAIL (APPLICANT 1) *

EMAIL (APPLICANT 2) *

http:// DEPARTMENT/ORGANISATION WEBSITE

STATE/TERRITORY *

http://
DEPARTMENT/ORGANISATION WEBSITE