Membership Registration Form

Business Trading Name
Contact Person(s)
Address
Town
Post Code
Phone
Fax
Mobile
Email
Web URL

Membership Scale
Associates	(non-profit community based organisations)	$66.00
Small Business	(up to 5 employees)	$77.00
Medium Business	(6 to 100 employees)	$121.00
Large Business	(greater than 100 employees)	$550.00
Corporate Sponsor		$1100.00+
In Kind Sponsor	(to the value of...)	$550.00+

Payment Method
A cheque made payable to Hunter Region BEC has been sent to P.O. Box 195, Kurri Kurri NSW 2327
Please call me on the above phone number to arrange credit card payment

I CONSENT top my name being provided to other companies for marketing purposes
I DO NOT CONSENT top my name being provided to other companies for marketing purposes