Fillable Membership Application 2022 CPC (National Asthma Council Australia)

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Membership Application 2022 CPC (National Asthma Council Australia)

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CPC
Membership Application 2022
Level 2, 137 Pyrmont Street Pyrmont, NSW, 2009 | Ph: 02 8297 3800 | ABN 84 140 893 152
MEMBER DETAILS
DECLARATION OF AUDITED OR PUBLISHED GROSS INCOME (TIER 1-4 ONLY)
SELECT MEMBERSHIP OPTION
Business Name:
ABN:
Physical Address:
Postal Address (if dierent):
Phone Number:
Company Email:
Contact Name (CEO/MD/EP):
Contact Email (CEO/MD/EP):
Tier 1 - 4 membership subscriptions are calculated annually
and are based on each company’s gross income for the
previous nancial year.
List your state oces, 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.
State Company Branch Name Gross Income Contact Name
(CEO/MD/EP)
Contact Email
(CEO/MD/EP)
Gross Income TOTAL (AUS) $
Gross income
TIER 1
$6 million +
TIER 2
$2 – $5.99 million
TIER 3
$1 – $1.99 million
TIER 4
Under $1 million
Sole Trader
N/A
OPTION 1
Annual Fee
$4,000* $2,250* $1,550* $1,000* $500*
OPTION 2
Annual Fee
$5,000*
Incl. AWARD
benets
$3,000*
Incl. AWARD
benets
$2,200*
Incl. AWARD
benets
$1,500*
Incl. AWARD
benets
Denition 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.
Page 1 of 2
*Excludes GST
CFO FD 3rd Party Accountant
CEO MD EP
Print Name Print Name
Sign manually or with Digital ID Sign manually or with Digital ID
Date Date
Condentiality
The Commercial Producers Council (CPC) promises and undertakes to the member as an ongoing separate promise and
undertaking that the CPC will not use the condential information provided in this form for any purpose other than calculating
the membership fee. The CPC will not disclose the condential information to any other person or permit any other person to
have access to this information.
RETURN COMPLETED FORM
CONFIRMATION
Please return this completed form via email CPC@commercialproducerscouncil.org.au
Need Help?
Call the CPC membership support team on 02 8297 3800 or email CPC@commercialproducerscouncil.org.au
As a member of the Commercial Producers Council (CPC), please notify the CPC in writing as soon as reasonably possible of any
signicant change to any information provided or any other information which would aect your eligibility for membership.
The member agrees that on joining the CPC it will be bound by the Code of Ethics, Data Collection Statement, Privacy Policy and
all other rules and regulations enforced by the CPC.
Page 2 of 2
Level 2, 137 Pyrmont Street Pyrmont, NSW, 2009 | Ph: 02 8297 3800 | ABN 84 140 893 152
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Membership Application 2022 CPC (National Asthma Council Australia)

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Completed 22 November 2021

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