Member Details

• Business Entity Name:
• Business Address:
• Business Website:
• Type of Business:
• Number of Employees:

Logo Usage

Approval will be sought for use of the RCH1000 logo on:

• business letterhead
• website
• Other

if 'Other', please specify:

Nominee Details

1. Name of Nominee:

Is the nominee an existing RCH1000 member?

• Yes
• No (if not, complete seperate Personal Membership Form).
• Nominee Phone Number:
• Nominee Fax Number:
• Nominee Email:
• Nominee Mobile:

Payment Details

1. Membership donation (tax deductable) *see below$
2. *Advertising (see advertising order form)$
3. Total$

* 75 or less employees $5,000
75 to 200 employees $10,000
more than 200 employees RCH1000 will contact you to discuss

Member Details

• Title Please select one Mr. Mrs. Ms Dr
• Address:
• Postcode:
• Phone:
• Fax:
• Email:

Please tick the appropriate box for the size of advertisement you wish to place for the RCH1000 Newsletter per annum (4 issues).

1. Total:$