TasCOSS

1. Contact Details

1.1 Full Name*

Please provide the full name of the person completing the application form.

Title Given Name(s) Surname

1.2 Position/Job Title

Please provide the position/job title of the person completing the application form (if applicable).

1.3 Email Address*

Please provide the email address of the person completing the application form.

Enter Email Confirm Email Address

1.4 Phone Number*

Please provide the phone number of the person completing the application form.

1.5 Street Address*

Please include the street address, suburb and postcode for your main office or residence.

Street Address Suburb State Postcode Country

1.6 Postal Address

Please include the postal address, suburb and postcode if different from street address provided above.

Postal Address Suburb State Postcode Country

2. Organisational Membership

The following questions are for those applying for Organisation Membership only. If you are applying for Individual Membership, please skip to 3. Membership Fees.

2.1. Organisation Name

Please provide the name of the organisation applying to be a member of TasCOSS.

2.2 Designated Member Full Name

Each Organisational Member of TasCOSS has one vote. The Designated Member votes of behalf of the organisation in a TasCOSS election. Please provide the full name of the Designated Member.

Title Given Name(s) Surname

2.3 Designated Member Position/Job Title

Please provide the position/job title of the Designated Member.

2.4 Designated Member Email Address

Please provide the email address of the Designated Member.

Enter Email Address Confirm Email Address

2.5 Designated Member Phone Number

Please provide the phone number of the Designated Member.

2.6 Key Contacts

As an Organisational Member of TasCOSS, all staff and volunteers will be treated as TasCOSS Members if your application is approved. Please provide contact details for people at your organisation in the areas of Human Resources (HR), Communications, Finance and any others you think would benefit from direct contact with TasCOSS. Please include each person's title, given name(s), surname, position/job title, contact email and phone number. Alternatively, upload a file with a list of contacts for your organisation below.

Upload Supporting Document(s)

2.7 Website

Please provide the website for your organisation (if applicable).

2.8 Full-time Staff

If you are applying as an Organisational Member, how many paid full-time staff work with your organisation?

2.9 Part-time Staff

If you are applying as an Organisational Member, how many paid part-time staff work with your organisation?

2.10 Casual Staff

If you are applying as an Organisational Member, how many paid casual staff work with your organisation?

2.11 Volunteers

If you are applying as an Organisational Member, how many volunteers work with your organisation?

3. Membership Fees

The following questions will be used to determine your annual Individual/Organisational Membership fee.

3.1 Are you applying for Individual or Organisational Membership of TasCOSS?*

Individual Membership
Organisational Membership

	Classification	Membership Fee (incl. GST)
*Individual Membership*	Waged / Employed	$75.00
*Individual Membership*	Unwaged / Concession	$15.00

	Core Annual Income Range	Membership Fee (incl. GST)
*Organisational Membership*	Less than $50,000	$70.00
	$50,001 – $99,999	$120.00
	$100,000 – $249,999	$175.00
	$250,000 – $499,999	$280.00
	$500,000 – $999,999	$390.00
	$1 Million – $2.49 Million	$575.00
	$2.5 Million – $5 Million	$705.00
	More than $5 Million	$990.00

3.2 Classification for Individual Membership*

Based on the information provided above, please indicate your Classification.

Waged / Employed
Unwaged / Concession

3.2 Core Annual Income Range for Organisational Membership*

Based on the information provided above, please indicate your Core Annual Income Range.

4. Questionnaire

4.1 What motivated you to join TasCOSS?*

[max. 250 words]

5. Declaration & Privacy

5.1 As an applicant for Individual/Organisational Membership, I support the Mission, Vision and Values of TasCOSS.*

Yes, I support the Mission, Vision and Values of TasCOSS.
No, I don't support the Mission, Vision and Values of TasCOSS.

5.2 Would you like a visit from one of our staff to explain TasCOSS Member Benefits?*

Yes, I would like a visit from one of our staff to explain TasCOSS Member Benefits.
No, I don't require a visit from one of our staff to explain TasCOSS Member Benefits.

5.2 Would you like a phone call from one of our staff to explain TasCOSS Member Benefits?*

Yes, I would like a phone call from one of our staff to explain TasCOSS Member Benefits.
No, I don't require a phone call from one of our staff to explain TasCOSS Member Benefits.

5.3 Would you like to receive the fortnightly TasCOSS enews and other occasional communication from TasCOSS about membership, training and events?*

Yes, I would like to receive the fortnightly TasCOSS enews and other occasional communication from TasCOSS.
No, I'm not interested in receiving the fortnightly TasCOSS enews and other occasional communication from TasCOSS.

Signature*

Date*

TasCOSS Membership Application

1. Contact Details

2. Organisational Membership

3. Membership Fees

4. Questionnaire

5. Declaration & Privacy