MEMBERSHIP FORM

Name: Mr Mrs Ms *

Company/Organisation *

Postal Address *

Phone number: *

Email *

Type of membership *

• Personal ($100 AUD)
• Corporate ($200 AUD)
• Overseas ($100 AUD)

Number of Employees (select) *1-910-99100 or more

States / Country where your business operates *

Type of ActivityRaw MaterialsSemi FinishedFinal ProductMachinery

Manufacturing/Producing / Extracting

.AgencyWholesaleLarge-Scale RetailRetail

Distribution

.Banking and financeLegalConsulting and AuditingOther Services

Services

.Raw MaterialsSemi FinishedFinals ProductsMachinery

Import / Export

Sector IndustryAgricultureITEnergyMiningTransportManufacturing

Other (please see our website for description of the categories)

Authorisation (select an option)

• I wish for my details to be shared with other members for business opportunities and contact
• I do not wish for my details to be shared with other members for business opportunities and contact

• I consent to the Australia-Ukraine Chamber of Commerce collecting and storing my data for administrative purposes

Name

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