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JOIN AS ASSOCIATE OR SPONSOR

To apply as Associate or Sponsor, you will need to complete the form below:

This information will provide EMICoL with a profile of your organisation, your company’s capabilities and cooperative initiatives such as training requirements and may be used to identify other initiatives that will be developed from time to time.

GENERAL APPLICATION FORM - Associate or Sponsor

ORGANISATION NAME:

ABN:
ACN:

PRIMARY CONTACT
First Name:
Surname:
Title:
Phone (Office):
Phone (Mobile):
Fax:
Email:

SECONDARY CONTACT
First Name:
Surname:
Title:
Phone (Office):
Phone (Mobile):
Fax:
Email:

POSTAL ADDRESS
Same As Above
Street:
Suburb: State:
Post Code:

Description of your Business:

**ENTITLEMENTS**
Entitlement	Description	Cost
Membership	Network with Cooperative Members	$2,500 + GST
Voting Rights	As a Supplier you will have no voting rights
Subsidised attendance at EMICoL events	Seminars, Training, Guest Speakers
Benefit from group activities	Opportunity to participate in group tendering

**ADDITIONAL SPONSORSHIP OPPORTUNITIES**
Sponsor a Breakfast Meeting	Network and provide a 15 minute company overview	$1,500
Sponsor a Guest Speaker	Sponsor an "Evening with..."	$2,000
Sponsor and EMICoL Dinner	Join with other sponsors to host an EMICoL Dinner	$3,000
Sponsor the EMICoL AGM	Be acknowledged as the only sponsor for this meeting	$4,000
Willing to sponsor other event	Yes - Describe:	$
	TOTAL	$

EVENT/BENEFIT/COST

PAYMENT: An invoice will be issued for payment on approval of your application.

INVOICE TO BE FORWARDED TO:
Organisation Name:
Attention:
Address:
Suburb: State: Post Code:

Yes, I am authorised to apply to be an Associate/Sponsor

Once your application has been considered by the Board of Directors, your nominated primary contact person will be notified in writing by mail.