Organisational Membership

Organisation Name

AKA (optional)

ABN (optional)

Purpose of organisation

Key issues managed by organisation

Fax (optional)

Chairperson

CEO

What areas of QACC's work most interests your organisation?

How do you think you can contribute actively to QACC's work?

How do you, or your organisation, want QACC work in partnership with your organisation?

And in what way do you want QACC to promote your organisation?

We shall make our payment as

Cash

Money Order

Electronic Funds Transfer