Membership Application Membership Application Applicant Company Name * Postal Address * Postal Address Postal Address Postal Address City City State State Postcode Postcode Phone * Fax Email * Primary SIA Contact * Mobile * Bank Branch If a Company or trading as a Business name or Partnership: Date of Incorporation or Registration A.C.N A.B.N Registered Office Address * Registered Office Address Registered Office Address Registered Office Address City City State State Postcode Postcode Directors Shareholders, Registered Proprietor(s), Partners Senior Executive Officer Principal Place of Business Years in Snow Sports Nature of Business Type of Goods sold Trade Reference 1: Name Trade Reference 1: Mobile Trade Reference 2: Name Trade Reference 2: Mobile Trade Reference 3: Name Trade Reference 3: Mobile SIA Member Proposers Proposer 1: SIA Member Name Proposer 1: SIA Member Email Proposer 2: SIA Member Name Proposer 2: SIA Member Email Fees Joining Fee: $1100 (inc GST) Annual Subscription: $500 (inc GST) Company Bank Account Name Business Phone Website Domain Email Public & Products Liability Insurance Details Insurance Company Policy Number Sum Insured (min $10,000,000) Policy Expiry Date Company Warehouse Address Company Warehouse Address Company Warehouse Address Company Warehouse Address City City State State Postcode Postcode A copy of a recent company bank statement and a current Certificate of Insurance for annual year-round Public and Products Liability Insurance for a minimum sum of $10,000,000, each in the company’s name, must be submitted with this application. File Upload (JPG, PNG or PDF, max 5MB) Drop a file here or click to upload Choose File Maximum upload size: 5MB Signature Applicant Name Date Signature Clear If you are human, leave this field blank. SEND