University Club Corporate Membership Nominee Application Form.

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University Club Corporate Membership Nominee Application Form

Member Company Name

Corporate Nominee Name(Required)

A Corporate Nominee form is required for each person appointed to the Corporate Membership and a minimum of 1 Corporate Nominee is required per Corporate Membership. Each nominee appointed to the Membership incurs a corporate subscription fee.

Prefix First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth

Phone(Required)

Email(Required)

Occupation(Required)

VEHICLE DETAILS

Please complete this section if the nominee wishes to receive a University Club parking permit allowing them to access the private members' parking area when visiting the Club. Only 1 permit is issued per Member

Vehicle Make and Model

Vehicle Registration Number

Complimentary Associate Membership for Spouse/Life Partner

Corporate nominees are entitled to appoint their spouse/life partner as a Corporate Associate Member. This is a complimentary Membership allowing full access to the University Club and is valid for the period that their spouse/life partner is a Corporate Member.

Yes, my spouse/life partner would like a Corporate Associate Membership. (An online Corporate Nominee application form will be sent)

No, I do not want a Corporate Associate Membership.

CLUB CHARGE ACCOUNT(Required)

Members are able to open a charge account for incidental expenditure at the Club. Charges are automatically deducted monthly from a nominated bank account or credit card.

Yes, I would like a member charge account.(Please complete settlement details below)

No, I would not like a member charge account.

Annual Subscription Fee Payment

Each corporate nominee appointed to the Membership is charged an annual subscription fee. Please indicate below the preferred payment method.

Annual subscription fees will be paid by my organisation

Annual subscription fees will be paid by me. (Please complete settlement details below)

Account Payment Method.

Please provide your preferred payment method. If you wish to pay via a credit or debit card, please do not provide details in this form. We will contact you to confirm card details in person.

Direct Debit from a nominated bank account. Please complete the payment section below

Credit or Debit Card - A member of staff will be in contact with you to confirm card details

Settlement Details

If your preferred method of payment is via a credit or debit card a Membership team member will contact you for card details.

Name and Branch of Your Financial Institution

BSB Number

Account Number

Account Name

TERMS AND CONDITIONS OF MEMBERSHIP

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 suspend my Membership for a minimum of three (03) to a maximum of twelve (12) months throughout the duration of my membership. All outstanding dues and food & beverage charges 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. It is agreed that I may suspend by giving no less than thirty (30) days advance written notice. Cancellation of Membership I agree to maintain my Membership for a minimum period of six (06) 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. Please note should the principal nominee cancel their Corporate Membership, the complimentary nature of Corporate Associate Membership no longer applies. Membership Card I agree to carry and present my membership card when visiting the Club. 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(Required)

I have read and understand both the Terms and Conditions of Membership and the “Important Information for Prospective Members” information sheet 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

YES

Name

Prefix First Last

Date