Membership Registration

Government Department

Private Industry - Company

Recruitment Agency

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General
Company name*		ABN/ACN*
Department*
Group / Executive*
Business address*
Suburb*	State* Postcode*
Invoice address (if different)
Suburb*	State   Postcode
Membership type*	GSX Classic
Recruitment agency*	Yes No
How many employees within your organisation*	1 - 10 11 -50 51 - 100 More than 100
Office locations	New South Wales Victoria South Australia Northern Territory Other	Australian Capital Territory Queensland Western Australia Tasmania
How did you found out about GSX?	GSX Conference/Launch GSX Sales Consultant Word of mouth GSX Advertising Referral ITCRA Member Other	Other
Contact details (person completing this form)
First name*
Last name*
Company position*
Phone
Email*
Principal / Manager contact First name* Last name* Phone Fax Mobile Email*		Finance contact First name* Last name* Phone Fax Mobile Email*
A Membership Manager account type is created based on the above Principal contact details. This account can then be used to add more user accounts via the Members' Lounge. To access the Members' Lounge you'll need to login using the username displayed below.
Username*
I have read and agree with the Membership Agreement
I am an authorised person for this company to complete this form

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