Registration Form

Personal Details

Tell us a bit about yourself. Fields marked * are required.

Referrer Member ID

Title*

*Mr./Ms...

First Name*

*First Name

Last Name*

*Last Name

Gender*

*Gender

Date of Birth (DD/MM/YYYY)*

*Date of Birth Pick

Address Line 1*

*Street Address

Address Line 2

Address line 2

Suburb*

*City

Postal code*

*Post Code

State*

*County/State

Country*

*Country

Email*

*Email

Phone number*

*Mobile Phone

Where do you work?

Tell us about your employment so we can best support you.

Employer Name*

*Employer

Employer Worksite*

*Employee Worksite

Department you work at

Employer Department

Industry*

Occupation*

*Occupation

Membership Type*

Annual Pay Bracket*

*Annual Pay Bracket

Payment

Choose your membership and how you'd like to pay.

Payment Frequency*

Subscription Price (AUD)

Subscription Price

Payment Method

Direct Debit

Credit Card

Direct Debit Details

BSB*

BSB Number

Account number*

Bank Account Number

Declaration & Submit

Please read and agree to the following before submitting.

I (your name)*

*I (your name)

Statement by Applicant

I hereby apply for membership of The Australian Workers' Union which is an organisation registered under the Fair Work (Registered Organisations) Act 2009.

I declare that the information provided above is true and accurate and agree to be bound by the registered rules of The Australian Workers' Union, which are publicly available on the website of the Fair Work Commission at this address: fwc.gov.au — AWU

I understand The Australian Workers Union may refuse my membership if any of the information outlined above is found to be false in any respect.

I undertake to inform The Australian Workers' Union within 14 days if my residential address changes, my place of work changes or if I retire from the workforce.

I understand that in order to resign from my membership with The Australian Workers' Union I must provide a signed notice in writing to the Branch Office by mail, fax, email or in person.

I agree*

I accept the terms and conditions of the AWU application criteria

Today's Date*

*Today Pick

Office Use Only

I confirm I am employed/contracted by the AWU and I have entered the relevant details in this form on behalf of the identified person with their express consent during a phone conversation.

I, name (AWU staff name)

Web Form Authority - Filled by AWU Staff

Payment Method

Direct Debit Details

Credit Card Details

Statement by Applicant

Office Use Only