All information provided is private and confidential. If there is information you don’t have yet please submit what you can now and resubmit the rest later.

Full Legal Name

ABN

Duration of term

6 months

12 months

Any changes or inclusions to the draft member agreement

Insurance provider and policy number

Emergency contact name and number

Any relevant medical information or accessibility requirements you would like us to be aware of

Short description of business to add to our website

Window signage

Your business name and either a website or socials address to display on the front window