TIBA Membership Application

ABN: 36 829 709 053

Application for Membership

Name

First Name Last Name

Home Address

Street Address

PO Box

City State / Province

Postal / Zip Code

Business Address

Street Address

PO Box

City State / Province

Postal / Zip Code

Type of Business:

Domestic Commercial Domestic/Commercial

ABN Number

Business Phone Number

Area Code Phone Number

Home Phone Number

Area Code Phone Number

Email

Website

I/we certify that I/we have never been refused or suspended from any organisation/association. This application remains conﬁdential between the applicant and the Association. I/we the applicant hereby
certify to the best of my/our knowledge and belief, the information supplied hearin is true and correct in
every particular. I/we give express authority to the Tasmanian Independent Builders Association and its
servants and agents where applicable to:

- make any enquiries it considers necessary to enable this application to be considered; and collect,
- use and disclose my/our personal information that amounts to sensitive information under the Act, as required to assess me/us for or provide me/us with relevant products or service.

I/we hereby agree if elected to membership of the Tasmanian Independent Builders Association to be bound by the Association’s constitution, rules and any by-laws or rules made in conformity thereof.

I/we further understand that to resign from membership I/we must do so in writing addressed to the Office Manager and that any dues payable but not paid to the time of receipt of written notice maybe recovered as a debt to the Association. Information used in this application maybe used by third parties.

Date

E-Signature

Clear

CC Reg. No. (If applicable)

Membership application fee $27.50 (one off)

Membership fee $300.00 per annum

Post checque to: 9 Warwick Street Hobart 7000

Direct Deposit:

My State

BSB: 807 009

Account No: 51395086

Office: 9 Warwick Street Hobart 7000 or email Sharon: sharonk.tiba@gmail.com