Water Industry Alliance

Membership Application Form

All fields marked in RED are mandatory and must be filled in.

Company Contact Details

COMPANY NAME
STREET ADDRESS:
SUBURB		STATE:
COUNTRY:		POST CODE:
POSTAL ADDRESS:
CITY / SUBURB:		STATE:
COUNTRY		POST CODE:
TELEPHONE:		FAX:
Please enter your complete company URL ie.http://www.yourcompany.com.au
COMPANY URL:
COMPANY EMAIL:
Company Details, Products & Services, Area of Specialisation 40-75 words (Handbook Profile)
PROFILE:

Primary Contact Person

FIRST NAME:		FAMILY NAME:
POSITION:		SALUTATION:
TELEPHONE:		FAX:
MOBILE NO:		EMAIL:
To register as a member you must chose a LOGIN NAME. This can be made up of your last/family name followed by your initials or first name. There is a minimum of 4 characters and a maximum of 12 characters, ie. surnameabc or brown_tom. Once your membership has been approved both your Login Name and Unique Password will be email to you. This will enable access to the Members Domain.
LOGIN NAME:

Alternatively you may telephone the Communication and Membership Manager, Anna-Marie Aubrey, on 61 8 7424 1161 or email comms@waterindustry.com.au. Thank you for your interest in registering for membership in the Water Industry Alliance.