Become a member - Online Registration


I wish to apply for MOSS Membership in the following category:
Please Select:
  
Individual NFP Professional @ $250pa allows for membership for one only member of the organisation

Not for Profit Organisation including universities @ $990pa allows for membership across the whole organisation

Individual Small Business Professional @ $330pa allows for individual membership only within the business (not exchangeable)

Small Business (under 10 employees) @ $1,200pa allows for membership of all personnel across the whole organisation.

Individual Government Professional @ $440pa allows for one only member within the organisation or Department.

Government Agency @ $990 allows for membership of up to three people across the organisation or agency.

Individual Corporate @ $550 pa allows for an individual non exchangeable membership within a large corporation.

Company @ $1,200pa provides exchangeable membership for up to 3 company executives within a large corporation.

Gold @ $10,000pa provides exchangeable membership for all company personnel across the whole organisation as well as a facilitated strategy workshop for senior executives using the Sustainability Challenge.

Student @ $110 allows for membership for full time students only.

Contact Details:
 
Organisation Name:
  
 
Principal Contact:
  
 
Title:
  
 
Phone:
  
 
Mobile:
  
 
Fax:
  
 
Email:
  
 
Postal Address:
  
 
Postcode:
  
 
Street Address:
  
 
Postcode:
  
 
Company web address:
  
Where relevant, please list other company representatives who should receive notification of events, newsletters etc
 
Name:
  
 
Title:
  
 
City:
  
 
Email address:
  
 
Name:
  
 
Title:
  
 
City:
  
 
Email address:
  
Please tick which category best suits your organisation:
 
Advertising & Media
                
Agribusiness
                
Air Quality
  
 
Architecture & Design
                
Banking & Finance
                
Capacity Building
  
 
Cause Related Marketing
                
Corporate Foundation
                
Corporate Governance
  
 
Corporate Community Engagement
                
Corporate Community Investment
                
CSR/Corporate Sustainability Consulting
  
 
Diversity
                
Eco-Tourism
                
Education & Training
  
 
Emissions Trading
                
Engineering
                
Environmental Management
  
 
Environmental Measurement
                
Environmental Repor ting
                
Human Resources
  
 
Human Rights
                
Industry Association
                
Insurance
  
 
IT
                
Legal & Compliance
                
Local Council
  
 
Manufacturing
                
Marketing
                
Measurement & Repor ting
  
 
Mining
                
NGO / Charity
                
Oil, Gas & Petroleum
  
 
Project Management
                
Public Relations / Public Affairs
                
Public Utility
  
 
Quality Assurance
                
Research
                
Recycling
  
 
Renewable Energy
                
Risk Management
                
Social Enterprise Development
  
 
Soil Restoration & Salinity
                
Standards
                
Supply Chain
  
 
Telecommunications
                
Transport & Automotive
                
Urban Planning and Development
  
 
Waste Management
                
Water Management
                
Volunteering
  
Your Company Details:
 
Please attach or email to info@moss.org.au a brief (50 words or less) statement describing your organisation along with a jpeg of your company logo
  
Please complete the relevant fields below:
 
I am paying a total of:
  
 
I wish to pay by:
  
 
Direct Deposit.
  
 
Cheque Details:
  
Credit Card details - Note a 2% processing fee is applicable to all credit card payments - COMPLETE ALL FIELDS
 
Name on card:
  
 
Credit card type:
  
 
Card number:
  
 
CVC No:
  
 
Expiry Month:
  
 
Expiry Year:
  


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Models of Success & Sustainability Pty Ltd (MOSS) ACN: 120 102 025
54 Eden Valley Road, Warranwood, VIC AUSTRALIA 3134
P:
+61 3 987 99 886 / 0419 798 104
| F: +61 3 987 99 884 | E: info@moss.org.au | W: www.moss.org.au

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