Fillable 2021 MEMBER DECLARATION FORM MEMBER DETAILS (National Asthma Council Australia)

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2021 MEMBER DECLARATION FORM MEMBER DETAILS (National Asthma Council Australia)

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2021 MEMBER DECLARATION FORM
MEMBER DETAILS
DECLARATION OF AUDITED OR PUBLISHED GROSS INCOME
Membership subscriptions are calculated annually and are based on each agency’s gross income for the previous financial
year. List your state offices, entities and subsidiaries that are part of your member subscription, including gross income*
per brand. If you require more space please do this on a separate sheet, and attach it to this form and email it to
Advertising Council Australia.
*Definition of Gross Income
Gross income means all fees, service fees, commissions and other income, including creative and
production income, earned by a member in the course of carrying on the business of marketing communications. This may include
planning, creative, producing and the delivery of advertising and marketing communications.
Group / Agency / Business Name
ABN
Physical Address
Postal Address (if different)
Phone Number
Company Email
Primary Contact Name/s
Primary Contact Email/s
Invoice Contact Name
Invoice Contact Email
State
Agency Name
Gross Income
Primary Contact/s (CEO/MD)
Contact Email/s
Gross Income TOTAL (AUS) $
ACA
PO Box Q1389, Sydney, NSW, 1230 | ABN 84 140 893 152
2021 MEMBER DECLARATION FORM
CONFIRMATION
As a member of Advertising Council Australia, please notify the ACA in writing as soon as reasonably possible of any
significant change to any information provided or any other information which would affect your eligibility for membership.
In signing the form, the member agrees to complete the ACA accreditation questionnaire as part of the membership
process. The member agrees that on joining Advertising Council Australia it will be bound by the Code of Ethics, Data
Collection Statement, Privacy Policy and all other rules and regulations enforced by Advertising Council Australia.
SIGNATURES
CONFIDENTIALITY
Advertising Council Australia (ACA) promises and undertakes to the member as an ongoing separate promise and
undertaking that ACA will not use the confidential information provided in this form for any purpose other than calculating
the membership fee. ACA will not disclose the confidential information to any other person or permit any other person to
have access to this information.
RETURN FORM
Please return this completed form by email to membership@adcouncil.org.au
QUESTIONS?
Call the Advertising Council Australia Membership support team on 02 8297 3800 or email
membership@adcouncil.org.au
CEO
MD
Managing Partner
CFO FD 3rd Party accountant
Print Name
Print Name
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Sign manually or with Digital ID
Date
Date
ACA
PO Box Q1389, Sydney, NSW, 1230 | ABN 84 140 893 152
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2021 MEMBER DECLARATION FORM MEMBER DETAILS (National Asthma Council Australia)

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Completed 18 November 2021

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