Member Application Member Application Complete the details below and submit your application to become a member of CRPA. HiddenNext Steps: Sync an Email Add-OnTo get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.HiddenMember ApplicationYour Name(Required) Title Mr.Mrs.MissMs.Dr.Prof.Rev. First Last Company / Business Name(Required) Trading Name (if applicable) ABN(Required)Year Established(Required)Position Held(Required) Phone(Required)Your Email Address(Required) Email Address Confirm Email Address Business Address(Required) Street Address Suburb State Post Code Detailed Business Activity(Required)Would you like a quote for insurance?(Required) Yes No Please complete if you would like an insurance policy quoteCRPA have successfully negotiated with insurance underwriters and can provide competitive insurance premiums. Complete the details below to see if you are eligible for our policy.Policy start date(Required) DD slash MM slash YYYY Limit of Liability cover required(Required) $10,000,000 $20,000,000 Estimated Annual Turnover(Required)Qualification(Required) Years of Experience(Required)Do you supply or sell products?(Required) Yes No What products do you supply / sell?(Required) How many employees do you have?(Required)Do you use subcontractors?(Required) Yes No Have you ever been declared bankrupt?(Required) Yes No Do you have a criminal record?(Required) Yes No Within the last five years has any claim been made against you?(Required) Yes No Please provide details of claim(s)(Required)Your Comments/Questions