Online Application – Civil Contractors Federation, Queensland

Product Name

Price: $ 0.00

Membership Type

Membership Start Date*

Membership Level*

Membership Fee

$ 0.00

SECTION 1 COMPANY DETAILS

Business Legal Entity Name*

Business Trading Name*

Choose your username*

This will be the username you use to login to the website.

ABN*

ACN

Business Address*

Street address and suburb State Postcode

POSTAL ADDRESS (IF DIFFERENT)

Street address and suburb State Postcode

Business Phone Number*

Business Fax

Email Address*

Mobile

SECTION 2 CONTACT DETAILS

Primary Contact (Voting and Constitutional Rights) - ie. Owner, Director or Senior Executive*

First Name Last Name

The Proprietor/Partners/Directors are:

Average Annual Turnover**

Current Number of Employees

** Annual gross turnover of the business in Queensland excluding GST per financial year

These Federation Members would be prepared to support this application

Proposer’s Name*

Seconder’s Name

Type of Business/Products

Is your company a Civil Train client?

Yes
No

If not, can a Civil Train representative contact you with information on Civil Train services?

Yes
No

Section 3 Additional Contact Details

AUTHORISED REPRESENTATIVE (person who will be contacted in relation to events, information and member visits)

Name

First Name Last Name

Position

Email

Mobile/Phone

FINANCE CONTACT (Accounts and Invoicing contact)

Name

First Name Last Name

Position

Email

Mobile/Phone

HEALTH AND SAFETY CONTACT (IR Support and WHS contact)

First Name Last Name

Position

Email

Mobile/Phone

TRAINING CONTACT (Civil Train, CCF Short Course contact)

Name

First Name Last Name

Position

Email

Mobile/Phone

ADDITIONAL CONTACT

Name

First Name Last Name

Position

Email

Mobile/Phone

Member directory

If you would only like to be in the private member only directory please only select yes to the first option but if you would like to be displayed in both the member only directory and the public directory please only click yes to the second option.

Do you want to be displayed in the member only directory?*

Yes
No

Do you want to be displayed in the public directory?*

Yes
No

Contractor Services

Associate Services

Geographic Areas Serviced

Company description

Company logo

The logo file should be a JPG, GIF or PNG file which is less than 3MB in file size.

Website address

Section 4 Confirmation

Personal Information*

All personal information you provide in this form will be used by the Civil Contractors Federation Queensland Branch and selected third parties in accordance with our Privacy Policy, which can be accessed on our website at www.ccfqld.com/home/privacy-policy/. A copy can also be obtained by calling us on 07 3360 7933 or by emailing us at ccfqld@ccfqld.com. By providing your personal information, you agree to such use. Please tick if you consent to us using your personal information for direct marketing purposes, including but not limited to enews, event update and QLD:INSIGHT

I Consent

Declaration*

I hereby apply to be admitted as a Member of the Civil Contractors Federation Queensland Branch and, if admitted, undertake to abide by the rules and ethics of the Federation, as amended from time to time, and also any regulations made by the Board of Directors in accordance with the rules.

How do you want to pay?*

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Email

This field is for validation purposes and should be left unchanged.

Online Application Membership > Online Application

SECTION 1 COMPANY DETAILS

SECTION 2 CONTACT DETAILS

Section 3 Additional Contact Details

Member directory

Section 4 Confirmation

CONNECT WITH US

Email:	admin@ccfqld.com
Phone:	1300 CCF QLD
Address:	11 Hi-Tech Court Eight Mile Plains QLD 4113