Membership Application Form

Membership Registration Form

Please complete and submit the application form below. After submission, you will be directed to checkout page for payment. If not, please check your inbox for further instructions. Select your preferred payment option and complete the transaction. Your membership will be confirmed once the payment is processed.

"*" indicates required fields

Company

This field is for validation purposes and should be left unchanged.

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Next Steps: Install the User Registration Add-On

This form requires the Gravity Forms User Registration Add-On. Important: Delete this tip before you publish the form.

Membership Selection

Please choose membership desired*

Government Membership

Construction/Developer Membership

Transport Operator Membership

Support Services Membership

Please select the Government Membership level desired:*

Prices are in AUD and exclude GST.

Commonwealth Government – $75,000

State/Territory Government – $50,000

Local Government – Tier 1 (Very Large) – $10,000

Local Government – Tier 2 (Large) – $7,000

Local Government – Tier 3 (Medium) – $4,000

Local Government – Tier 4 (Small) – $3,000

Please select the Construction/Developer Membership level desired:*

Prices are in AUD and exclude GST.

Construction/Developer – Tier 1 (Very Large)- $35,000

Construction/Developer – Tier 2 (Large) – $15,000

Construction/Developer – Tier 3 (Medium) – $2,500

Construction/Developer – Tier 4 (Small) – $1,500

Please select the Transport Operator Membership level desired:*

Prices are in AUD and exclude GST.

Transport Operator – Tier 1 (Very Large) – $10,000

Transport Operator – Tier 2 (Large) – $5,000

Transport Operator – Tier 3 (Medium) – $2,500

Transport Operator – Tier 4 (Small) – $1,500

Please select Support Services Membership*

Price is in AUD and exclude GST.

Support Services – $1,500

Want to join as a Supply Page Partner program?

Yes

Please select the Supplier Category you are applying for:

Vehicle Safety Technology and Equipment

Logistics Management

Training Services

Other

Please tick the Supplier Tier you are applying for (prices are in AUD and exclude GST):

Supply Page Partner Tier 1 – $5,000 (Receive 100% discount on Support Services membership)

Supply Page Partner Tier 2 – $2,500 (Receive 10% discount on Support Services membership)

Supply Page Partner Tier 3 – $1,500 (Receive 5% discount on Support Services membership)

Government/Company Details

Government Entity Name/ Company Name*

Trading Name*

ABN No.

Website

Business Address*

Street Address Address Line 2 Suburb State / Province / Region ZIP / Postal Code Country

Postal Address*

Same as Business Address

Street Address

PO BOX

Address*

Street Address Address Line 2 Suburb State / Province / Region ZIP / Postal Code Country

Contact Person Details

Contact Person*

First Name Last Name

Phone*

Email*

Enter Email Confirm Email

Stakeholder

Type of Stakeholder in Relation to the CLOCS-A Standard*

Please indicate*

CLOCS-A Accreditation Details

Are you a CLOCS-A Accredited organisation?*

Yes

List your CLOCS-A sites and tier level*

Please include your CLOCS-A accredited sites, accreditation level, registration number and expiry date.

Do you have CLOCS-A accredited vehicles?*

Yes

List your CLOCS-A vehicles and tier level*

Please include your CLOCS-A accredited vehicles, accreditation level, registration number and expiry date.

Do you have both CLOCS-A accredited sites and vehicles?*

Yes

List your CLOCS-A vehicles and tier level*

Please include your CLOCS-A accredited sites and accredited vehicles with their respective accreditation level, registration number and expiry date

Quality Assurance Details

Name of Person responsible for Quality

Position of Person responsible for Quality

Are you Certified to ISO 9001 standard?*

Yes

Name of Certification Body*

Certification Number*

Please list any other approvals held:

Please upload copies of certificates held

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 50 MB.

Environmental Management System (EMS) Details

Name of Person responsible for your EMS

Position of Person responsible for your EMS

Are you Certified to ISO 14001?*

Yes

Name of Certification Body*

Certification Number*

Please list any other approvals held:

Please upload copies of certificates held

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 50 MB.

Membership Registration Form

Next Steps: Install the User Registration Add-On

Membership Selection

Government/Company Details

Contact Person Details

Stakeholder

CLOCS-A Accreditation Details

Quality Assurance Details

Environmental Management System (EMS) Details

Declaration and Consent