Organisational Membership Form Organisation Membership Application Organisation Name Website/URL Name of Primary Contact Primary Contact Phone Primary Contact Email Primary Contact Address CEO Name CEO Email Please provide a brief description of your organisation Please briefly state why you want to be a member of GEN VIC Do you consent to GEN VIC using your answer to the above question in our marketing and communications? Yes Yes, but only if it is anonymous No Please state how your organisation: advances gender equity; and supports GEN VIC’s vision for an equitable where people of all genders can thrive. Do you agree to the rights and responsibilities outlined in the GEN VIC Membership Policy? Read it here (copy and paste this link into your browser search bar): tinyurl.com/3nx25znf Yes No Please tick the size of your annual revenue so that we can determine your membership fee (excluding GST) Less than $250,000 ($125 Membership Fee)Less than $500,000 ($250 Membership Fee)Less than $1 Million ($500 Membership Fee)Less than $3 Million ($750 Membership Fee)Less than $5 Million ($1000 Membership Fee)More than $5 Million Not-for-profit ($1500)Defined Entity/Duty Holder ($3000 Membership Fee)$5-10 million ($5000 membership fee)More than $10 Million ($10000) Please note that organisations may apply for a variation of membership fee dependent on circumstances. Please contact GEN VIC via the contact details below if you would like further information. To finalise your application, we ask that an authorised representative of your organisation verifies that all information provided is true and correct. Submit If you are human, leave this field blank.
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