APPLICATION FOR NATIONAL EMU WEBSITE ADVERTISING (12 month)

Date of Application: _ _ /_ _/ _ _ 
Registered Business/Company Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
Full Name of Applicant: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Position: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _	
Other Partners/Directors: 
(1) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(2) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
(3) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
Postal Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
Phone Business: _ _ _ _ _ _ _ _ _ _ _ _  After Hours: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Mobile: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Facsimile: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Email:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Website: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
Member of Affiliated Organisation/s: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Circle option applying for: 	Option 1. Advertising without website link ($75)
Option 2. Advertising with website link ($100)

Conditions of Advertising
* The period of advertising is for 12 months and commences on the 1st of the month following authorisation of application.
* The content of the advertising is at the discretion of EFFA and no advertising will be permitted which refers to any other organisation. No misleading or false claims will be accepted.
* The applicant, partners and directors of the company are to be fully paid up members of an EFFA Member Organisation and remain fully paid up members for the entire period of advertising. If any membership/s lapses at any time during the period of advertising, the advertising will be suspended immediately.
* Advertising will not commence until proposed advertisement and payment is received and cleared. Payment to be made by cheque or postal order to EFFA.
* Space size of advertising is 190mm x 50mm and should include company name/logo, contact details and description of goods or services provided.

Declaration:
I/we understand and agree to comply with the conditions of advertising and any and all regulations as set out by EFFA and any and all directives given by EFFA.
I/we agree to conduct our business in a responsible, ethical and professional manner.
I/we understand that should we fail to comply, this advertising may be suspended or terminated.
I/we declare that all details of this application are true and correct.

Signed (By all Partners/Directors): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 

Date: _ _ /_ _/ _ _
EFFA use only.        Authorised by: 	                                                         Date: