Date of Application* |
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Registered Company Name | |||||||||||||
Trading Name (if different from above) | |||||||||||||
Email (for accounts) | |||||||||||||
Physical Address | |||||||||||||
Postal Address (if different to above) | |||||||||||||
Phone | |||||||||||||
Website | |||||||||||||
Primary contact | |||||||||||||
Name* | |||||||||||||
Designation | |||||||||||||
Email* | |||||||||||||
Mobile | |||||||||||||
If you would like others within your company/organisation to receive Council notifications please advise | |||||||||||||
Please indicate which other Councils you belong to |
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Industry Sector (select from drop down menu) | |||||||||||||
Membership Category | |||||||||||||
Full membership |
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Payment the amount of | |||||||||||||
Will be paid by the following method |
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Direct Credit | |||||||||||||
Date Paid |
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Ref: Company Name | |||||||||||||
ANZ account: NZ Tonga Business Council 030162 0172956 00 | |||||||||||||
Credit Card | |||||||||||||
Type of Card | |||||||||||||
Card # | |||||||||||||
Expiry Date |
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Name on Card |