ACA Qld Principal Membership (Ordinary Member) Application

How did you hear about us?

Approved Provider / Ownership Details

Company Name/Trading Name

Approved Provider ID

Your Local Government Area

Number of services you own or manage

Postal Address

Address Line 2

City

State/Region/Province

Postal / Zip Code

Country

Approved Provider Contact Person

The Approved Provider of the Principal Service (Ordinary Member) will have authority to vote at Annual General Meetings. In accordance with The Rules of the Association a proxy may be appointed in writing prior to these meetings. You may appoint a Nominated Representative to vote on behalf of your service at General Meetings. Your nominated representative will also be your approved Employer Services contact.

Phone Number

Mobile

Email Address

We would like this Contact Person to be the Accounting Contact on file

Accounting Contact Name

First Name

Last Name

Accounting Contact Email

Nominated Representative

The Approved Provider of the Principal Service (Ordinary Member) will have authority to vote at Annual General Meetings. In accordance with The Rules of the Association a proxy may be appointed in writing prior to these meetings. You may appoint a Nominated Representative to vote on behalf of your service at General Meetings. Your nominated representative will also be your approved Employer Services contact.

First Name

Last Name

Principal (Largest) Service Details

Please enter below the details of the service with the largest licensed capacity.

Principal Service Name

Principal Service Approval ID

Principal Service Nominated Supervisor

My Postal Address is the same as my Principal Service Address

Service Address if different from Postal Address

Street Address

Address Line 2

City

State/Region/Province

Postal / Zip Code

Country

Service Phone Number

Service Email Address

What is the Principal Service's Licensed Capacity?

Membership Level Individual

Is your service insured with Guild Insurance?

Is the Service Building

I would like to receive updates and exclusive offers from ACA Qld Supporter Members

I acknowledge that it is a fundamental principle of ACA Qld that all services owned or operated by an Approved Provider, Owner, Management Company or group of associated entities must also join ACA Qld.

Additional Service Details

Number of Additional Services

Additional Service