Principal Membership (Ordinary Member)

The ACA Qld Membership Year runs from 1 April – 31 March. Please enter information on the form below to join ACA Queensland.

Only Ordinary Members or their Nominated Representative have the right to vote at General Meetings

Approved Provider / Ownership Details

Company Name / Trading Name *

Provider ID *

Contact Person *

Do you trade as

Company

Partnership

Sole Trader

Trust

Incorporated Association

Other (Please give details)

No of services you own or manage

Postal Address *

Suburb *

State *

Postcode *

Phone *

Mobile *

Email *

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.

Nominated Representative *

Principal Service Details

The Principal Service is the service with largest licensed capacity.

Principal Service Name *

Principal Service ID *

Nominated Supervisor

Service Address *

Suburb *

State *

Postcode *

Postal Address if different to above:

Suburb

State

Post Code

Phone *

Email *

What is the Principal Service’s Licensed Capacity? *

Membership Level *

Is the Service insured with Guild Insurance? *

Is the Service Building

We may provide your information to ACA Qld Supporter Members (suppliers), so they are able to communicate with you directly about their products and services. If you do not wish for us to share your information, please tick the box

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Additional Service Details

It is a fundamental principle of ACA Qld that all services owned/operated by an Approved Provider or Management Company must also join ACA Qld.

Number of Additional Services *

Additional Service Name *

Additional Service ID *

Additional Service Approved Place *

Nominated Supervisor

Service Address *

Suburb *

State *

Postcode *

Phone *

Email *

Additional Service Name *

Additional Service ID *

Additional Service Approved Place *

Nominated Supervisor

Service Address *

Suburb *

State *

Postcode *

Phone *

Email *

Additional Service Name *

Additional Service ID *

Additional Service Approved Place *

Nominated Supervisor

Service Address *

Suburb *

State *

Postcode *

Phone *

Email *

Additional Service Name *

Additional Service ID *

Additional Service Approved Place *

Nominated Supervisor

Service Address *

Suburb *

State *

Postcode *

Phone *

Email *

Additional Service Name *

Additional Service ID *

Additional Service Approved Place *

Nominated Supervisor

Service Address *

Suburb *

State *

Postcode *

Phone *

Email *

By submitting this application, you confirm that all information provided is true and correct and will notify us in writing of any changes. You understand and agree to The Rules of the Association, a copy of which can be found on the ACA Qld website.

Payment Information

Payment Terms

$475.00 for each Year

Regular subscription price

Regular subscription discount amount

Regular subscription tax

Payment Fee

Regular gross amount

Payment Method

Offline Payment

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

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Principal Membership (Ordinary Member)

Approved Provider / Ownership Details

Principal Service Details

Additional Service Details

Payment Information