Membership of the Australia Pacific Islands Business Council

Name of Company

Postal Address

Street Address

Nature of Company/Business

MEMBERSHIP CATEGORY MEMBERSHIP CATEGORY Full Member (all countries) ($1670 per annum including GST) Limited Member (2 or 3 countries) ($1115 per annum including GST) Associate Member (one country) ($ 590 per annum including GST)

Member's Representative to the Council Member's Representative to the Council

First Name

Last Name

Designation

Position

Telephone

Email Address

Please indicate countries of interest if registering as Multiple or Single Country Member Please indicate countries of interest if registering as Multiple or Single Country Member American Samoa Cook Islands CNMI Federated States of Micronesia French Polynesia Guam Kiribati Nauru New Caledonia Niue Palau Republic

How did you learn of the council? How did you learn of the council? Event Colleague Web Other

If others, please specify