APPLICATION FOR MEMBERSHIP
TRADING NAME: ___________________________________
CONTACT NAME: _____________________ ____________
ADDRESS: ______________________________________
______________________________________
______________________________________
Telephone: ______________________________________
Mobile: ______________________________________
Fax: ______________________________________
Email: ___________________________________
Chemical Application License: YES/NO Expires: ____________
Number of Years spraying Experience: ________________________
£ Full Voting: $330
£ Corporate: Non-voting $550
NSW Groundsprayers Association
Peter Broughton
Mobile: 0419 126 059
ABN: 57 359 326 438
Mail cheques to:
NSW Groundsprayers Association
3555 Murringo Road
YOUNG, NSW 2594
Cheque payable to NSW Groundsprayers Association for $ _________________
Direct Deposit Details:
Account Name: NSW Groundsprayers Association Incorporated
Bank Commonwealth Bank
Branch YOUNG
BSB 062630
Account No 10157233