Territory Proud Membership Application





Your Business (*)
Please add a value for Your Business.
ABN (*)
Please add a value for ABN.
What is your NT Business Number? (*)
Please add a value for ABN.
Address (*)
Please add a value for Address.
Suburb, Town or City (*)
Please add a value for Suburb, Town or City.
State (*)
Please add a value for State.
Post Code (*)
Please add a value for Post Code.
Contact (Your Name) (*)
Fullname must contain only a-z,A-Z characters
Postion (*)
Please add a value for Postion.
Phone Number (*)
is not a number.
Fax (*)
Fax is not a number.
Email Address (*)
Please add a valid e-mail address.
Website (*)
Please add a value for Website.
Description of Business (*)
Please add a value for Description of Business.
Business Category (*)
Please add a value for Business Category.
Membership Level (*)
Please add a value for Membership Level.
How many Territorians do you employ? (*)
Please add a value for Do you employ at least 1 Territorian in your business.
Total number of Employees? (*)
Please add a value for Do you employ at least 1 Territorian in your business.

Terms and Conditions of Membership of Territory Proud

We agree to abide by the Constitutions and By-Laws of Territory Proud Inc and acknowledge that our membership entitles us to use the Territory Proud logo on our stationery, uniforms, promotional material and motor vehicles for a period of 12 months.

We further acknowledge that should our membership cease for any reason we will no longer use the Territory Proud logo and will remove it use by our business.

By clicking the 'submit' button you acknowledge and agree to the Terms and Conditions specified above.