Membership of the Australia Pacific Islands Business Council

Name of Company

Nature of Company/Business

Postal Address Postal Address

Address

Town/City

State

Postcode

Country

Street Address Street Address Same as above Different

Address

Town/City

State

Postcode

Country

MEMBERSHIP CATEGORY MEMBERSHIP CATEGORY Full Member (all countries) ($1750 per annum including GST) Limited Member (2 or 3 countries) ($1175 per annum including GST) Associate Member (one country) ($ 700 per annum including GST)

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

Honorific

First Name

Last Name

Position

Email Address

Telephone Telephone

Country/Area Code

Number

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 of the Marshall Islands Samoa Solomon Islands Tokelau Tonga Tuvalu Vanuatu Wallis and Futuna

How did you learn of the council? How did you learn of the council? APIBC Event Business Colleague Website Social Media Other

If others, please specify