Clone of MBNT Membership Application Form

Master Builders NT

Membership Application Form

Please ensure you have all documents ready to complete your application.
- Insurance documents
- References
- Trade licences
- Director information
Please complete and submit this form to apply for membership. One of our memebrship team will be in touch once submission has been made.

Membership Application Form
Business Information

Please complete all fields
Business Trading Name
Business Entity Name
(As shown on ABN registration)
ABN
ACN
Address

Street Address

Street Address Line 2

CityState / Province

Post Code
Postal Address

Street Address

Street Address Line 2

CityState / Province

Post Code
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Reason for joining- Please select all that apply

Other
How did you hear about us?
Have you been a previous member?
If yes, what was your member number?
Website URL
Facebook URL
Linked In URL

Directors / Business Partners

Please note: Director 1 will be listed as the primary representative who has authority to vote on behalf of the company.
Director 1

First NameLast Name
Position
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Do you have other Directors or Business Partners?
Director 2

First NameLast Name
Position
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Has any applicant, Principle or Director had any past or present association with any company/business that ceased to trade, had an official manager appointed, placed in liquidation or entered a scheme of arrangement with creditors?
Has any Applicant or a Director/Partner ever been disciplined/prosecuted in relation to their business activities?

References

Relevant to the building and construction industry. Please ensure your referees have been contacted prior to us getting in touch.
Reference 1
Company
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Reference 2
Company
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com

Membership Category

Please choose from the following options below
If your business is multiple categories please select the category where the majority of your work is conducted

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Privacy Statement
Master Builders NT respects your privacy and is committed to protecting the personal information collected. You may have access to the information, provide changes to contact details or opt-out of receiving direct marketing activity at any time by contacting the MBNT office by phone on (08) 8922 9666 or email info@mbant.com.au

I/we authorise Master Builders NT to make any enquiries deemed necessary to qualify my application.

I/we undertake, if accepted as a Member of Master Builders NT, to abide by the Master Builders NT Code of Practice.

Consent to Share Data
I/we understand that MBNT will manage my information in accordance with its Privacy Policy, and that I may access or update my personal information, or withdraw consent to share certain data, by contacting MBNT at any time.

By signing this form, I/we acknowledge and consent to Master Builders Northern Territory (MBNT):

• Collecting, storing, and using my personal and business information for the purposes of administering my membership, providing member services, and communicating with me.

• Sharing relevant information with third parties where reasonably necessary to deliver member benefits (such as training providers, event organisers, sponsors, insurers, or government agencies), subject to appropriate privacy safeguards.

• Using my contact details to send me information about MBNT programs, industry updates, advocacy, and events, unless I choose to opt out of marketing communications.

•Including my name, business name, and contact details in MBNT’s membership directory (available to members only), unless I notify MBNT in writing that I do not wish to be included.
I / we consent to receiving updates from MBNT about industry news, events, training, and advocacy (I may opt out at any time).

Acknowledgement

If my application is accepted, I undertake to advise Master Builders NT of any changes to my business activities, that may affect the membership category granted or any of the other information supplied on this form.
By completing this MBNT Membership Application, I agree to the following terms & conditions:
I authorise MBNT to make my/our business name & Logo available on the MBNT member online directory.
Name

First NameLast Name
Position
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature of authrorised company representative
Should be Empty:

Master Builders NT

Membership Application Form

Please ensure you have all documents ready to complete your application.

Membership Application Form

Business Information

About your business

Licencing

Insurance

Trades and Services

Directors / Business Partners

Contacts

References

Membership Category

Membership Subscription Fees

Please select the most appropriate subscription Fees

Rates

Privacy Statement

Acknowledgement