Membership Application Form

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

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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 disregard.
- Yes, I give permission to DSA to share due diligence with DSANZ
Full Name*
First Name Last Name
Date
DD slash MM slash YYYY

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

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APPLICATION FOR DSA MEMBERSHIP