Membership Application Form Step 1 of 7 14% APPLICATION FOR DSA MEMBERSHIP Applicants for DSA Membership are assessed against criteria aimed at promoting industry professionalism and consumer protection. To commence the application process applicants are required to give the following information and provide transactional documentation as required to evidence compliance with the DSA Code of Practice. A non-refundable AUD$500 application fee should accompany this application. #ProudToBelong Please contact DSA should you have any queries. Email: askus@directselling.org.au Phone: 02 9138 0636 APPLICANT CONTACT DETAILS Person to be contacted about this application* First Name Last Name Title* Email* Direct Phone*(Please include country & area codes)Mobile* APPLICANT ORGANISATION Organisation Name* Australian Business Number (ABN)* Please provide a short introduction of your company*Company Logo (High-Res PNG Preferred)*Max. file size: 256 MB.Is your company a member of another DSA or applying to be one in another Country?* Yes No If yes, please list the countries you are a member of or applying to be one.Registered Office* Address Line 1 City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Business Address (if different to registered office) Address Line 1 City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Postal Address (if different to registered office) Address Line 1 City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Contact DetailsWebsite* Generic Email* Phone*(Please include country & area codes)Company DetailsCountry of Origin* Country of Ownership* Australia New Zealand U.S.A United Kingdom Other If other - Please specify: Trading as* Sole Trader Partnership Company Registered For GST* Yes No Please confirm the above information and proceed to the next section* Yes No CONTACTS Chief Executive* First Name Last Name Title* Email* (In keeping with the DSA Constitution, Member organisations must nominate a person to be the primary contact, to represent and bind the Member with the Association and receive all relevant communications – the authorized representative is able to vote at the AGM on behalf of the member) DSA Authorised Representative* First Name Last Name Title* Email* Direct Phone*(Please include country & area codes)Mobile*(The Code requires Members designate a person to manage their complaint handling system and who will act as the point of contact with the Association in any related matters)Code Liaison Officer (Person responsible for upholding DSA's Code of Practice)* First Name Last Name Title* Email* Direct Phone*(Please include country & area codes)Mobile*(Name of the person responsible for the organisation's financial operations)Chief Financial Officer* First Name Last Name Title* Email* Direct Phone*(Please include country & area codes)Mobile*Person DSA should send invoices to:* Authorised Representative CEO or GM Chief Financial Officer Please confirm the above information and proceed to the next section* Yes No DIRECT SELLING MODEL Business Model (Indicate if more than one)* Party Plan Hybrid Door to door Independent Sales Person (ISP) Agreement* Agency (Paid Commission) Distributor (Buy / Resell) Combination (Buy / Resell plus Commission for online sales) Who are payments for products made directly to?* Company Independent Sales Person Combination (ISP and direct to Company for online sales) Compensation Plan* Single Level Multi Level Start-Up Costs for ISP’s is in the form of* Consultant Sales Kit Training Fee Website Literature No Start-Up Costs Sales Kit Cost AUD$* Sales Kit Retail Value AUD$* Training Fee Cost AUD$ Website Cost AUD$ Literature Cost AUD$ Is there more than one price point for Start-Up?* No Yes If yes, please provide details Is a refund offered for return of Kit / Inventory?* Yes No If yes, please provide details Is a refund offered for unused literature?* Yes No If yes, please provide details Number of ISP’s (in Aust.)* Sales at retail value (in Aust.) for previous calendar year:* AUD$0 – $500K AUD$501K – $1.0M AUD$1.0M – $1.5M AUD$1.5M –$2.0M AUD$2.0M – $2.5M AUD$2.5M –$3.0M Other Other please advise Please confirm the above information and proceed to the next section* Yes No PRODUCT DETAILSProduct Categories* Aromatherapy Cleaning Products Clothing & Accessories Cosmetics Food Products Health & Wellness Household & Decor Jewellery Kitchenware Learning Products, Toys & Stationery Nutritional Drinks & Supplements Scrapbooking & Crafts Services Skincare, Personal Care & Fragrances Other Other – Please Describe Brand Name(s) & Product DescriptionAustralian Register of Therapeutic Goods – Are your products* Listed Awaiting Approval Does Not Apply If applicable, what are the listed products with TGA and their ARTG number?If applicable, what are the products that are in process of obtaining TGA approval?Are your products also sold through* Retail Outlets Online Autoship Direct Marketing Wholesale Markets/Fairs Pop Up Kiosks Do you have a Written Guarantee?* Yes No Do you have an Unconditional Guarantee?* Yes No Customer Guarantee* 30 Days 60 Days 3 Months 6 Months One Year More CommentsPlease confirm the above information and proceed to the next section* Yes No DOCUMENTATION A copy of each of the below listed documents is required to consider your application. Please indicate below which of the documents are currently available. Documents can be submitted as an attachment to this form, by email to askus@directselling.org.au or mail to DSA, Level 16/175 Pitt Street, Sydney NSW 2000 Australia. We will upon receiving your application, reply with an acknowledging email complete with a list of any missing documentation. Point of Sale Transactional Documentation Customer Order Form Customer Invoice Customer Guarantee Customer Order FormMax. file size: 256 MB.Customer InvoiceMax. file size: 256 MB.Customer GuaranteeMax. file size: 256 MB.Current Version of Your Distributor/Consultant Agreement Manual / Policies & Procedures Privacy Policy (If applicable) Distributor/Consultant AgreementMax. file size: 256 MB.Manual / Policies & ProceduresMax. file size: 256 MB.Privacy Policy (If Applicable)Max. file size: 256 MB.Full Details of Your Compensation Plan Starter Kit Compensation PlanMax. file size: 256 MB.Starter KitMax. file size: 256 MB.Are these documents currently in final form? Yes No Is Your Financial Advice Provided* In House By an Independent Professional Name* First Name Last Name Organisation (if by an Independent Professional) Email Phone(Please include country & area code)MobileIs Your Legal Advice Provided* In House By an Independent Professional Name* First Name Last Name Organisation (if by an Independent Professional) Email Phone(Please include country & area code)MobilePlease confirm the above information and proceed to the next section* Yes No DECLARATION*I am authorised to make this declaration: To the best of my knowledge and belief the Applicant’s business operations including the use of point of sale and marketing documentation complies with relevant law. The Applicant agrees as a condition of Membership to promptly inform the Association of any change in its circumstances, including material changes to its point of sale and marketing documentation, its authorised representative and/or designated person responsible for administering the complaint handling system. Authorisation - If you are intending to submit an application for membership with Direct Selling Association New Zealand (DSANZ), please tick the box below authorising DSA to share the due diligence with DSANZ. This will streamline your application process. If this is not applicable to you, please select no.* Yes, I give permission to DSA to share due diligence with DSANZ No, I do not wish DSA to share due diligence with DSANZ Full Name* First Name Last Name Date* DD slash MM slash YYYY PROCESSING FEE A non-refundable processing fee of AUD$500.00 is payable with this application.Payment Gateway Preferred* Paypal / Credit Card Non-refundable Application Processing Fee (AUD)* Price: PhoneThis field is for validation purposes and should be left unchanged.