Membership Application Form

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Membership Application Form

Which Safer Together Chapter do you wish to join?

QLD WA/NT Both QLD & WA/NT

Please tick relevant category

Full Membership Categories	FEES (AUD) + GST	FEES (AUD) + GST
Operator Companies	QLD or WA/NT	QLD & WA/NT (BOTH)
Tier 1 Operator	$83,200	$124,800
Tier 2 Operator	$23,900	$35,850
Non-Operator Partner	$9,900	$14,850
Exploration	$3,950	$5,925
Contract Partner Companies	QLD or WA/NT	QLD & WA/NT (BOTH)
Australian turnover more than AUD 100 million	$9,900	$14,850
Australian turnover AUD 50 - 100 million	$5,900	$8,850
Australian turnover AUD 10 - 50 million	$3,950	$5,925
Australian turnover less than AUD 10 million	$1,980	$2,970

Members are divided into categories solely for the purpose of determining the annual fee to be paid. Members rank equally in all other respects.

Company Details

Company Name *

Telephone *

Address *

Company Website *

Facebook

Twitter

Vimeo

Key Personnel

Most Senior In-Country Line Leader

Name *

Position Title *

Telephone *

Email *

HSE Focal Point

Name *

Position Title *

Telephone *

Email *

Operations/Communications Focal Point

Name *

Position Title *

Telephone *

Email *

Learning & Development Focal Point

Name *

Position Title *

Telephone *

Email *

Invoicing Details

Contact Name *

Position Title *

Telephone *

Email *

Invoice Address *

Permission to use logo

We request permission to use your company logo in Safer Together materials for the following specific purposes:
Website - In a list of member companies of Safer Together on our website safertogether.com.au with a link to your company's website
Print - In a list of member companies of Safer Together for use in brochures flyers and posters
Video - In a list of member companies of Safer Together for use in video clips

Name of person completing this form *

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Membership Application Form

Please tick relevant category

Company Details

Key Personnel

Most Senior In-Country Line Leader

HSE Focal Point

Operations/Communications Focal Point

Learning & Development Focal Point

Invoicing Details

Permission to use logo

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