WOMEN ON THE MOVE
MEMBERSHIP APPLICATION
Email address *
Your Name *
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Business / Employer Name: *
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Industry: *
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Business Address: *
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Your Role/ Position: *
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Postal Address: *
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Mobile Phone:
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Home Phone:
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Work Phone:
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Please provide a description of your business. *
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How did you hear about Women On The Move? *
Name of Person who referred you:
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Is there anything else you'd like to tell us? *
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MEMBERSHIP FEES
The WOTM Annual Membership fee is $35 Individual (Full Financial Year); $70 Corporate Level 1 (Full Financial Year for 3 or Less Staff) and $100 Corporate Level 2 (Full Financial Year for 4+ Staff).

Your membership commences from 1 July, on receipt of your membership fee together with your completed application form.

NOTE: Cancellations of memberships will attract a full refund if received within 14 days of application. After this time no refunds will be made, however for a small administration fee of $2.00 for individual memberships maybe transferred to another party.
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DIRECT DEBIT DETAILS
Name: Women On The Move Incorporated
Bank: Bank of Queensland
BSB: 124-052
Account Number: 22687386
DISCLAIMER
I agree that I attend Women on the Move Incorporated functions, events and meetings at host venues or otherwise of my own free will and I accept all liability and responsibility for all inherent risks of property and personal damage and waive any and all claims present and future resulting from ordinary negligence, or otherwise, on the part of the Women on the Move Incorporated. 
Photos may be taken at these events, and I acknowledge these photos may be used in promotional materials and displayed on the Women on the Move Incorporated website. 
Any personal information provided by me to Women on the Move Incorporated for this membership will be held in accordance with the Privacy Act 1988 (Cth) and not divulged to any third party without my express consent. My email details will be added to the email database.
Please tick here if you DO NOT wish to have your photo used in our marketing and promotional materials
AGREEMENT AND SIGNATURE
I certify that the information I have provided is true and correct. I agree and acknowledge that I have read, understand and accept the above terms of membership. 
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THANKYOU
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