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Application for Membership
Name:*	Position:*	Email:*
(Full Name of 1st Member Representative)	(Position of 1st Member Representative)	(Email of 1st Member Representative)
Name:	Position:	Email:
(Full Name of 2nd Member Representative)	(Position of 2nd Member Representative)	(Email of 2nd Member Representative)
of: (Name of firm - Proposed Members)
Address:*	Post Code:*
Contact Phone Number:*	Fax Number:*	Website:
Principal Business Activity:

On behalf of the above named company I hereby apply for membership of the Western Sydney Business Connection Incorporated. I am aware of the annual membership subscription set out below and any possible resignation of membership must be given one month in advance and in writing to the Secretary. I understand that the firm is ‘the member’. As the applicant and first member representative, I will be the recipient of all correspondence including invitations, accounts and general information and my name will appear on the membership list as the member representative, unless notified otherwise. However, a second and third representative may be added to the business register.



Name of Applicant to start the application:*
		Date:*
I,*	a member of the association, nominate the applicant, who is personally known to me, for membership of the association.
Name of the Proposer to start the application:*		Date:*

I,*	a member of the association, second the nomination.
Name of the Seconder to start the application:*		Date:*

		Please forward completed application to: The Western Sydney Business Connection Inc. PO Box 4032 PARRAMATTA NSW 2124

WSBC Membership Levels* Platinum Sponsorship* $9,880.00 p.a. Gold Membership* $3,950.00 p.a. Silver Membership* $1,770.00 p.a.		Phone: (02) 9687 2788 Fax: (02) 9687 2789
Manufacturers Connection Manufacturers Gold $5,200.00* p.a. Manufacturers Silver $2,600.00* p.a.
All prices plus GST.

NOTE: A copy of this form will be emailed to you upon submitting your application form. To complete the application process please PRINT the emailed form, sign and FAX or POST back to WSBC.



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