Master Builders SA Membership Form 2019.1

Master Builders SA - Membership Registration

V2019.1
Have you been a member of the Master Builders Association SA Inc previously?

Yes No
Previous Member Number (if known)
Where did you hear about Master Builders?
Who is the member?
This member will receive $100 off their next membership invoice as a thank you for recommending you to Master Builders SA.
Primary Contact Details
First Name *
Last Name
E-mail: *
This email is used for all primary correspondence
Direct Phone
Mobile Phone
Date of Birth

Day Month Year
Date Date Picker Icon

Company Details
Type of Business *
Company Name:
Business Name:
To appear on Membership Certificate
ACN:
If Applicable
ABN:
If Applicable
Postal Address:
Address 1
Address 2
Suburb
State
Postcode
Is your Company Address the same as Postal Address?

Yes No

Company Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Main phone number:
Are your primary contact details the same as your accounts details?

Yes No
Accounts email address:
Accounts phone number:
Number of Employees
Do you contribute to an Industry Super Fund

Yes No N/A
If YES to an Industry Super Fund, which one?

Insurance break
Insurance
Do you have a current Liability &/or Construction Works Insurance policy?

Yes No
Expiry date of your Liability &/or Construction Works Insurance?
Month and year
Who is your current insurer?
Do you have current Builders Indemnity Insurance?

Yes No
When does your current policy expire?
Month and year

Director Partner Info hide
Director / Partners Information
Name of Director 1

First Name Last Name
Name of Director 2

First Name Last Name
Name of Director 3

First Name Last Name
Name of Director 4

First Name Last Name
Has the Applicant or any Principal or Director had any past or present association with any company/business that ceased to trade, had an official manager appointed, was placed in liquidation or entered into a scheme of arrangement with creditors?

Yes No
If Yes, what year?
Has the Applicant or a Director/Partner ever been disciplined/prosecuted in relation to their business activities?

Yes No
If Yes, what year?

Payment Options
Subscription fees are for 1 year.

All fees are inclusive of GST.
Member Advisor
MBA reference
staff only
Discount
staff only
Payment options *

Direct Debit (12 monthly payments) Full payment via Credit Card Invoice
As you have selected Direct Debit. -

Once you click SUBMIT the direct debit form will appear for you to fill out the Direct Debit details. Please do not close the Direct Debit form until you have completed.
Payment Terms

3 months 6 months 9 months 12 months
An invoice will be sent to your nominated email address on the form. Payment will be required prior to becoming an active member
TOTAL Membership (Inc GST)
Annual renewal
Monthly Membership (Inc GST)
If paid monthly via Direct Debit for the year
SC CC total
todays date

Day Month Year
Date Date Picker Icon
Comments
To become a member of Master Builders SA your application for membership must be approved by the Council in accordance with our Constitution and section 166 of the Fair Work (Registered Organisations) Act 2009. Pending approval, you will be provided with full access to Master Builders SA products and services. In circumstances where your application is not approved by the Council you will be refunded your full membership subscription, and all online accesses to member products will be denied.

If my application is accepted I undertake to advise the Master Builders Association SA Inc. of any changes to my business activities, that may affect the membership category granted or any of the other information supplied on this form. I authorise the Master Builders SA to make all necessary enquiries to qualify my application. Master Builders respects its obligations to protect personal information it collects, holds and uses about individuals it deals with. Master Builders SA collects and uses personal information necessary to provide services to the individual. Personal information may be obtained from, and disclosed to, internal staff of the Master Builders and any other third parties engaged to provide services to the Master Builders SA or the individual. Master Builders SA may use personal information for direct marketing to provide individuals with information about our products and services. An individual may contact us to request that they no longer want to receive marketing communications and each communication provides opt out options. To see our full Privacy Policy, visit our website at www.mbasa.com.au or make a request by contacting us. The privacy policy contains information about how you may access or correct information held about you, and how to make a privacy complaint.
After clicking Submit, you will receive an email notification of the membership application form.

If you have any queries, you can contact Master Builders SA on 08 8211 7466 and ask for the membership team.

Thank you for your membership
Terms and Conditions approval

I accept the terms and conditions
Applicant Signature *

Clear
Payment via Credit Card

Please note AMEX is not accepted
A Direct Debit form will be required to be filled out and first payment made upon completion of this form.

DO NOT CLOSE THE DIRECT DEBIT FORM BEFORE CONFIRMING YOUR DIRECT DEBIT.
Should be Empty:

	Licence Number	Name on Licence	Pending (yes/no)
Personal License
Company License

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Master Builders SA - Membership Registration

Primary Contact Details

Company Details

Insurance

Director / Partners Information

Membership Types

Payment Options

Payment via Credit Card