Business Membership

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Please complete and return the below form for application for membership to EnviroIndustry Gold Coast Inc.

Fields marked with (*) are required.

Trading Name: *	Full Business Name (if different from trading name):
ABN or ACN: *	Website Address:

Business Synposis: *

Street Address: *	Postal Address:
Suburb: *

Does your business only operate in Queensland?:* Yes No	If your answer is no, please indicate where your business also operates Specify other states / territories: Overseas (please specify where)
Number of equivelent staff in Gold Coast office: *	Method of Payment: *

Business Size	Membership Cost(including GST)	Select Size: *
0 - 5 Employees	$110
6 - 20 Employees	$275
20+ Employees	$550