Lead Membership

Lead Membership Form

Company name

ABN*

Postal Address*

Suburb

Phone number*

Website Address*

Appointed Representative

Appointed Representative Name

Position

Phone number

Mobile phone number

Email*

APGA point of Contact (optional) - for distribution of APGA information within your organisation.

Point of Contact Name

Point of Contact Position Title

Point of Phone Number

Point of Mobile Number

Point of Contact Email

Accounts Department Contact

Accounts Department Phone Number

Accounts Department Email

Interest Group (Please tick one only: choose the one most applicable to your business.)

Sector Please indicate which industry sector you are primarily working in (please tick ONE ONLY).

YOUNG PIPELINERS FORUM (YPF) REPRESENTATIVE - for distribution of YPF information within your company. You will find full information on the YPF on the APGA website at http://www.apga.org.au/ypf.

YPF Name

YPF Position

YPF Mobile Number

YPF Phone Number

YPF Email

We hereby apply for Corporate Membership of the Australian Pipelines and Gas Association in the Category and Interest Group indicated above and agree to abide by the Company’s Constitution and any By-laws set from time to time.

Lead Membership Form

Appointed Representative

APGA point of Contact (optional) - for distribution of APGA information within your organisation.

Accounts Department Contact

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