Membership Application Form

Applying for membership of BioMelbourne Network

Organisation details

Further details to support application

Senior primary contact details

Secondary contact details (optional)

Declaration

Applying for membership of BioMelbourne Network

Organisation details

Further details to support application

Senior primary contact details

Secondary contact details (optional)

Declaration

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Membership of BioMelbourne Network covers all employees in your organisation. Once your membership application has been submitted and approved by the BioMelbourne Network Board, we will contact you for payment and information that will enable us to promote your organisation on our website.

Organisation name *

Address *

Industry *

Membership type *

View membership types and rates here: biomelbourne.org/become-a-member

Is this company ASX listed?

Company website (URL)

Company social media accounts

e.g. LinkedIn, Twitter

These answers give our Board a better understanding of who you are and where your interests lie.

Provide a short description of your business, and how this relates to BioMelbourne Network. *

What are your primary reasons for joining BioMelbourne Network? *

What would you like to get out of your BioMelbourne Network membership? *

Please enter the details of an executive level contact to receive key member communications.

Title

First Name *

Last Name *

Position *

Mobile Number *

Other Contact Number

Email *

You can choose to enter the details of a secondary person that will appear on our website as your organisation’s public facing contact.

Title

First Name *

Last Name *

Position *

Mobile Number *

Other Contact Number

Email *

By submitting this form you are confirming that you wish to become a member of BioMelbourne Network Incorporated and you agree to be bound by BioMelbourne Network Rules of Incorporated Association for the time being in force. Access the BioMelbourne Network Rules of Incorporated Association here: https://biomelbourne.org/wp-content/uploads/2020/11/BMN-Rules-of-Incorporation-Victoria-2014.pdf

Date

« July 2021 »