Primer – Regional Terms: $250 / year Personal Details Title Mr Ms Mrs Miss First Name* Middle Name Last Name* Email* Business Email* Choose a Username Password* Confirm Password* Password Confirmation Doesn't Match Preferred Name Gender Male Female Date Of Birth* Mobile Other Phone Position Title* Select Director Owner Partner Business Development Manager Administrator Accounts Marketing Manager Supervisor Were you referred by anyone? Select Roger Stevenson MPA Skills Other Member Other Other* Reason for joining Do you belong to any loyalty programs? Select Dulux Accredited Wattyl ProDiscounts LikeMinded Painters Haymes Paint Aussie Painters Network Other Enter if you belong to other loyalty programs Company Details Business/Trading Name* Additional Email Business Primary Phone* Business Secondary/Mobile Number Business Secondary/mobile no. Belongs To Director Owner Partner Business Development Manager Administrator Accounts Marketing Manager Supervisor Business Secondary Phone Name Business Web Address Are you an Individual or Organisation? Select Individual Organisation Business ABN Name Business ABN Business Type Select Australian Private Company (Pty Ltd) Family Trust Individual/Sole Trader Partnership Unit Trust Other Other* Business Postal Address Business Postal Address Business Postal Address 2 Business Postal Suburb Business Postal Address State Business Postal Address Postcode Business Physical Address Business Physical Address Business Physical Address 2 Business Physical Suburb Business Physical Address State Business Physical Address Postcode Residential Address Residential Address Is Same As Business Postal Address? Enter Residential Address Electoral Roll Address If you are a voting member of the Association (painting contractor) we will require your electoral roll address. Voting is handled by the Australian Electoral Commission, who will have your address on record. If your electoral address is not used as the business postal address please complete 'Electoral Roll Address' section below. Electoral Roll Address Is Same As Residential Address? Enter Electoral Roll Address Other Details Contractor's Registration Number Contractor's Registration Expiry Date* Name of Registered Practitioner Practitioner's Registration Number Practitioner's Registration Expiry Date* To be eligible for membership you must have the appropriate insurances in place, attach copy of your current Public Liability certificate (& Workers Compensation certificate for SATIN or GLOSS membership) Public Liability Policy No.* Public Liability Insurer Name* Public Liability Insurance Expiry Date* Public Liability COC Interest Tags Select MP and DA Training:Lead Removal MP and DA Training:Wallpaper Do you have Facebook? Yes No Facebook Do you have LinkedIn? Yes No LinkedIn Do you have Google+? Yes No Google+ Business Find A Painter Select Yes No Company Logo Note:The minimum width for the image is 300 pixels in jpg format. Business Service Categories Asbestos Removal Licence Commercial over $500K Commercial up to $100,000 Commercial up to $500k High Risk Licence ›10m Historic Restorations Industrial Coatings Lead Removal New Housing Payment Terms Pensioner/Senior Discount Repaints Roof Coatings Texture Coatings Wall papering White Card Working at Heights up to 10m Special Finishes Other Painting Special Finishes Details For example: Special Finishes (marbling; metallic; ragging; sponging; suede; textures) Other Details Business Service Areas Esperance Region Geraldton Region Great Southern Kalgoorlie Region Metro CBD Metro North-East Metro North-West Metro South-East Metro South-West North West Region Peel South West Region Are you a business host employer of apprentices? Yes No Total Number of Workers* Number of Tradesmen* Number of Subcontractors* Number of Apprentices* Number of Administration* Apprentice Technical Training MPA Skills TAFE Balga TAFE Thornlie Do you employ your apprentices through? All Hosted All Directly Employed Combination of Both Interest Tags Industry Issues What's New in the Industry White Set Plaster Other Events Apprentice of the Year Awards for Excellence Competition Awards for Excellence Gala Dinner MP&DA Training Apprenticeship Asbestos Management Building your Business Decorative/Special Finishes Industrial Coatings Lead Removal Spray Painting Wallpaper Working at Heights Other Industry Issues Please fix the errors above
