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Organisation requesting membership:
Company*
Please enter full registered business/organisation name
Industry*
Which industry sector does your business belong to?
How many employees does your business/organisation have in Australia?
Postal Address*
Street or PO Box Address Line 2 City State Postal code Country
Street Address*
Address Line 1 Address Line 2 City State Postal code Country
Key contact for Membership
Key contact Name*
First Last
Position
Key contact Phone*
Key contact Email*
Accounts Payable Contact:
Accounts Contact Name*
First Last
Position
Accounts contact Phone*
Accounts contact Email*
New Membership:
Pride in Diversity Membership Tier*
Would you like to package a tax deductible philanthropic donation of $4000 with your membership?*
- Yes
- No

In which capital city would you prefer your Relationship Manager to be located?*
Website Inclusion
Please tick if you would like to be listed as a member on our Pride Inclusion Programs website, and/or if you would like a company profile on our Inclusive Employers Website. You can opt in or out at a later stage if you wish.
- www.prideinclusionprograms.com.au
- www.inclusiveemployers.com.au
Social Media*
Do you consent to us announcing your membership on our social media channels?
- Yes
- No
Referral Path
How did you find out about Pride in Diversity?

Payment & Immediacy of Membership / Sponsorship Benefits
- You will receive an invoice of your membership fee within 3-5 days of submitting this form and our terms of payment are 14 days from date of invoice. Payments may be made via credit card, via EFT or our online gateway via the address stated on the invoice.
- Membership applications will be processed and immediately effective upon agreeing to the T&C’s and submitting the above form.
Payment Term:
- Our payment terms are 14 days. Please ticket here if you request a 30 day payment term.
I agree to the Terms & Conditions*
Click here to download the Terms & Conditions
- Yes

Please submit this form by clicking Submit below.
You will receive an email with link to the credit card payment.
Once submitted, a member of the team will be in contact with you within two business days

Please submit this form by clicking Submit below

Organisation requesting membership: