WFA Membership Application Form
COMPANY/TRADING NAME *
CONTACT NAME *
ADDRESS *
ACN/ABN NUMBER *
PHONE NUMBER *
MOBILE NUMBER *
EMAIL ADDRESS *
WORK COVER INSURANCE NUMBER *
PAID TO *
PUBLIC LIABILITY INSURANCE DETAILS *
PAID TO *
RED CARD NUMBER AND COURSE DATE *
SIGNATURE (Type Your Name) *
Type the following:
For security purposes, please type the letters in the image.