Application | Grain Producers SA

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Member Application

Applicant

Title

First Name

Last Name

Partner

Title

First Name

Last Name

Business

Business/Trading Name

ABN

Address

Address Line 1

Address Line 2

Town

State

Postcode

Contact Details

Email

Phone

Mobile

Fax

National Grower Register

NGR Card Name

NGR Card Number

Declaration

I wish to apply to be admitted as a member of Grain Producers SA Limited and confirm that I will be bound by the constitution of the company;
I am an active producer of grain in South Australia;
I am able to meet the membership requirements of Grain Producers SA Limited;
I have paid levies and/or contributions (or levies and/or contributions have been paid on my behalf) under the Wheat Marketing Act 1989 and/or the Primary Industry Funding Scheme Act 1998 or other government legislation which is in force from time to time;
I am at least 18 years of age;
The information I have provided above regarding my personal and business details is true and correct;
I consent to the information I have provided to be recorded by Grain Producers SA Limited on the register on Members;
I consent and authorise Grain Producers SA Limited to use and disclose all of the information on this application form and other information I provide Grain Producers SA Limited to any person or organisation for the purpose of enabling Grain Producers SA Limited to provide services to me;
If all of the requested information is not provided by me, then I acknowledge that Grain Producers SA Limited may not be able to provide services to me and I may not be eligible to cast a vote or discuss matters at meetings of the company.

I have read and agree to the above declaration

Terms & Conditions

Read the Grain Producers SA Terms & Conditions

I have read and agree to the terms & conditions