Please print details in capital letters

1. Application Details

Full name of Applicant:    

Postal Address:   

Telephone:    

Fax:    

Email Address:    

2. Industry Background

How long have you been in the security industry?  years

Are you an approved trainer with your state licensing regulator   YESNO

If No are you intending on becoming a trainer/assessor?  YESNO

Do you hold a relevant trainers qualification such as the BSZ40198, TAA40104 or TAE40110?
Please state which one YESNO

Whom do you work for or intend working for?    

What area/s of the security industry do you feel you hold most experience/knowledge?

Would you be interested in taking part in steering committees in relation to the above topics?

 YESNO

2. Professional Development

In relation to what topics would you like to complete professional development offered by the STA?

3. Declaration

Undertaking

I / We, certify that to the best of my / our knowledge and belief the information given in this application is true and correct in every detail. I / We authorise STA to make any enquiries it considers necessary to enable this application to be considered.

I / We agree, if elected to membership, to be bound by Model Rules, Policies and Procedures.

Payment

Full 12 month individual membership is $165 (GST inclusive). Monthly fee pro-rata leading up to end of term (June 30) is $12.50 per month(+GST).  Payment will be required via Cheque, Direct Debit or PayPal on the following screen.

I / We further understand that I / We may resign from membership by giving three months written notice to the Association and all fees due and payable during that period apply. I / We also understand that, in the event of my / our resignation from the association any fees or monies owing to the Association during the period in which the resignation takes effect are a debt due to the Association. 

Signature of the Applicant/s  

Applicant Name:    

Title:    

Date: