2022 - 2023 Western Australia Full Membership Application If you have any queries regarding membership or would prefer a PDF/Word version of this form please contact CHIA: [email protected] Member name (legal trading name) ABN/ACN CEO (or equivalent) name CEO email CEO phone numberEmail for invoice (if different) Postal Address Street Address City State / Province / Region ZIP / Postal Code Street Address Street Address City State / Province / Region ZIP / Postal Code Website Chairperson name Chairperson Email Community housing asset numbers- please record the number of owned and managed tenancies for each state as at 31 May 2022. State and Territory totals will be calculated automatically, TenanciesOwnedManagedTotalACTACT tenancies - ownedACT tenancies- managedACT tenancies totalNSWNSW tenancies- ownedNSW tenancies- managedNSW tenancies- totalNTNT tenancies - ownedNT tenancies - managedNT tenancies - totalQLD QLD tenancies - ownedQLD tenancies - managedQLD tenancies - totalSASA tenancies - ownedSA tenancies - managedSA tenancies - totalTASTAS tenancies - ownedTAS tenancies - managedTAS tenancies - totalVICVIC tenancies - ownedVIC tenancies - managedVIC tenancies - totalWAWA tenancies - ownedWA tenancies - managedWA tenancies - totalTotalTotal OwnedTotal ManagedTotal tenanciesThe membership fee = base rate + tenancy rate. The base rate is $322.00 (inc. GST) for members with more than 25 tenancies. For members with 25 tenancies or less the base rate is $161.00 (inc. GST). The tenancy rate is $3.31 (inc. GST) per tenancy. An invoice will be sent to you on the return of this renewal form. Consent Consent and acknowledgement (completed by person authorised on behalf of the member)By signing this form, we (being the organisation or individual named on this form) agree to the following: • We consent to becoming a member of the Community Housing Industry Association Ltd (CHIA) – CAN 604 344 112, a company limited by guarantee under Corporations Act 2001 (Cth) and agree to be bound by CHIA’s constitution. • If CHIA is wound up, we undertake to contribute to CHIA’s asset up to an amount not exceeding $1.00 for payment of CHIA’s debts and liabilities including the costs of the winding up. This undertaking continues for one year after we cease to be a member. • We appoint the person named on this form as the organisations main contact as our representative for the purposes of section 250D of the Corporations Act 2001 (Cth). Date MM slash DD slash YYYY Name First Last Position Website Listing Please tick this box if you do not wish your organisation to be listed on CHIA's website
