Water Services Associaton of Australia
ABN 54 117 907 285
WSAA membership application
Applicant details
Organisation name
Street address
Postal address
Phone
Website Email
Membership category
Please tick the category that applies to your organisation
International Utility Member Private Utility Member Utility Member
Number of water
supply connections
Stakeholder Member Consultant/Supplier Member
Applicant representatives
For the purposes of the Constitution of the Company the applicant nominates:
Full name
Position title
Email address
Full name
Position title
Email address
Signature of applicant
Date
In the event of its admission as a member, the applicant agrees to be bound by the
Constitution of the Company.
Please tick this box to indicate you have read and understand the WSAA
Constitution (2014) specifically: Clause 6(j) A Member may resign from the
Company by giving two year's notice in writing to the Board.
Water Services Associaton of Australia
ABN 54 117 907 285
WSAA Board representatives
For the purposes of the Constitution of the Company the following WSAA Board Members
nominate the applicant (arranged by WSAA):
Full name
Signature of proposer
Date
Full name
Signature of proposer
Date
Contact
Completed application forms should be sent to:
Jaimie Hicks
Business Development Manager
jaimie.hicks@wsaa.asn.au
0450129499