Corporate Membership

Company or Organisation Name (The Corporate Membership remains the property of the Corporate Member organisation. Corporate Member organisations are entitled to transfer the Primary corporate nominee as require) *

Main Office Address *

City *

State / Province / Region *

ZIP / Postal Code *

Country *

Postal Address (if applicable)

City

State / Province / Region

ZIP / Postal Code

Country

ABN *

Corporate Membership Primary Contact.

This person will be the University Club's primary contact within the Corporate Member organisation. The Primary contact does not have to be the same as the Corporate Nominee appointed to the Membership.

Title *

First Name *

Vehicle Registration Number *

Primary Contact Position *

Primary Contact Email Address *

Primary Contact Telephone Number *

CORPORATE NOMINEE DETAILS

Main Member for the Corporate Membership

Corporate Nominee Application

Corporate Membership is linked to, and managed by, one full fee-paying ($353/year) Corporate Nominee. In order to keep the Corporate Membership active, there must be one Corporate Nominee appointed to the Membership at all times

Title *

First Name *

Last Name *

Are you a current Member of the University Club of Western Australia *

Yes

Membership Number(if you are a current Member)

Date of Birth *

Corporate Nominee Address *

City *

State / Province / Region *

ZIP / Postal Code *

Country *

Club Account Request - Members with valid payment details on file are able to charge incidental expenditures such as food and beverage purchases and member events to their Member accounts *

Yes, I would like a Club Account. (Please complete settlement details below)

No, I would not like a Club Account.

Corporate Nominee Settlement Details - please read

The completion of this section is required if the Corporate Nominee is responsible for the payment of the annual subscription fee, and/or would like to set up a Club Account (See above)

Please nominate your preferred payment method *

Direct Debit from a nominated bank account.

Credit or Debit Card

Please provide your preferred payment method. We will reach out to you to confirm the details in person.

CORPORATE DELEGATES

Additional Members can be appointed to the Membership as Corporate Delegates ($180/ delegate/year). Corporate Delegates can be appointed to the Membership at any time and can be paid for by the Member organisation or the Corporate Delegate Directly. If you would like to appoint Corporate Delegates to this application, please complete their name and email address below and an online application form will be sent to them directly.

Would you like to add Corporate Delegates *

Yes(Fill Corporate Delegate Details Below)

Corporate Delegate Name

Corporate Delegate Email Address

Corporate Delegate Name

Corporate Delegate Email Address

Corporate Delegate Name

Corporate Delegate Email Address

Corporate Delegate Name

Corporate Delegate Email Address

CORPORATE MEMBERSHIP SETTLEMENT DETAILS

Corporate Membership subscription fees are paid annually via automatic deduction from a nominated credit/debit card or bank account.

I authorise the below credit/debit/bank account to settle the all subscription fees attached to this Corporate Membership *

Yes (Nominate your preferred payment method))

No- please send an invoice.

No-the Corporate nominee and/or Corporate delegates will settle their subscription fee/s. (Corporate delegates will be required to provide settlement details on their corporate delegate application form/s

Please nominate your preferred payment method

Direct Debit from a nominated bank account.

Credit or Debit Card

Please provide your preferred payment method. We will reach out to you to confirm the details in person.

Ezidebit account payment Terms and Conditions - Click Here To View

I authorise Ezidebit Pty Ltd ACN 096 902 813 (User ID 342190, 428198) (“Ezidebit”) to debit payments from my account, at intervals and amounts by The University Club of Western Australia Pty Ltd (“The Business”)as per the Terms and Conditions of my agreement with the Business and in accordance with this Direct Debit Request and the DDR Service Agreement. *

Additional Application Requirements. In addition to this form, please provide a corporate profile with a list of directors (if applicable) and a letter detailing why the organisation would like to become a Member and any links to UWA and/or the University Club or its membership. Please upload the supporting documents below

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Corporate Membership Terms and Conditions of Membership

Corporate Membership Applications Please note that Corporate Membership applications for the University Club of Western Australia require additional documents for the review of the Membership Subcommittee. All Corporate organisations MUST be able to illustrate a strong link with the University of Western Australia. All applications require a letter of introduction, corporate profile including a list of Directors in addition to any documentation illustrating the organisations link to UWA. UWA Alumni appointed as Corporate nominees deem that company automatically eligible. All letters and profiles are still required. Suspension of Membership It is agreed that I may go on absence and suspend my Membership for a minimum of three (3) to a maximum of twelve (12) months throughout the duration of my Membership. A written notice and all outstanding dues payable will be settled prior to my Membership being suspended and I agree to provide correct contact details valid for the duration of the Membership suspension. Cancellation of Membership I agree to maintain my Membership for a minimum period of six (6) months. It is agreed that I may cancel my Membership by giving no less than thirty (30) days advance written notice and payment of all outstanding dues and charges. It is also understood that dues and charges owing may not be offset against the Joining Fee paid by the Member. Transfer of Nominee It is understood that the Corporate Membership belongs to the Company. If a selected Nominee leaves the Company, the Company can elect a new Nominee at its discretion. The Nominee leaving the Company is not able to retain Corporate Membership, however, can transfer to an Individual Membership. Assumptions of Liability It is understood that subject to The University Club By-Laws and Regulations, and those that may be enforced from time to time, The University Club of Western Australia shall determine the dues that will be charged to Members. Membership of the Club does not confer upon me any ownership or liability for the property and assets owned by the Club. I agree that I am responsible for the charges incurred by me and my Guests in the use of the facilities and amenities of The University Club of Western Australia.

Declaration - Terms and Conditions - Click Here To View further information

I have read and understand the Terms and Conditions of Membership and the information provided on this form and agree that acceptance of the Membership application implies that I accept the By-Laws and Regulations of The University Club. I also fully understand that the Membership Sub-Committee reserves the right to approve or reject my application without assigning any reasons whatsoever.

Consent - Click Here To View

I have read and agree to The University Club of Western Australia Member's Code of Conduct as set out below. *

Full Name *

Position Title

Date *

Consent

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Application - Corporate Membership

CORPORATE NOMINEE DETAILS

CORPORATE DELEGATES

CORPORATE MEMBERSHIP SETTLEMENT DETAILS

Ezidebit account payment Terms and Conditions - Click Here To View

Declaration - Terms and Conditions - Click Here To View further information

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Application - Corporate Membership

CORPORATE NOMINEE DETAILS

CORPORATE DELEGATES

CORPORATE MEMBERSHIP SETTLEMENT DETAILS

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