Select your option to join us (Member or Subscriber) and complete the form. ’Subscriptions Name*Email*Mobile Phone*State (for which you would like to receive info)*WAACTNTQLDNSWVICTASSASpecial Interest (preferred subject area) Membership Application NameFirstLastAddress*Street AddressCityZIP / Postal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweCountryState*WAACTNTQLDNSWVICTASSAMobile** Your mobile number will be used as Payment Reference. Please make sure the number is correct.Email*Specialisation (if any)Membership Type*Select OneSubscriberLevel 0 StudentLevel 1 GeneralLevel 2 Gen PractitionerLevel 3 PractitionerLevel 4 PractitionerLevel 5 Para ProfLevel 6 ProfessionalLevel 7 ProfessionalLevel 8 ProfessionalFellowLife memberCorporate Membership Levels Level Category Typical Employment Equivalent to Quals & Experience Typical Work Tasks FEE Level Student Student Full time Student - (non voting) nil Level 1 General General Interest Safety Induction Trainee or general safety interest - (non voting) $100 Level 2 Gen Practitioner Elected HSR Cert III Competent skilled operative - (non voting) $150 Level 3 Practitioner Technician Cert IV Advanced competent skilled autonomous worker. $200 Level 4 Practitioner Technical Advisor Diploma 3 years experience Advanced skilled autonomous worker. $250 Level 5 Para Prof Coordinator / Supervisor Assoc Dip 5 years experience Competent administrator, specialist technician or paraprofessional. $300 Level 6 Professional Project or Department Manager Degree 7 years experience Competent senior administrator or specialist manager. $350 Level 7 Professional Company Manager Honours Degree 10 years experience Competent professional or senior manager. $400 Level 8 Professional Regional Corp Manager Master Degree 15 years experience Competent senior professional or executive level manager $450 Fellow Recommendation By vote at GM Special Service in Advancing Safety $450 Life member Recommendation By vote at GM Special Service to SIWA Nil Corporate $1500 Total$ 0.00For Corporate members only: The details above will be recognised as the Company address details and contact person CompanyACN, ABN, ARBNSignature*I being the person/company rep above, agree to comply with the constitution of “SIWA Limited” ACN 149 147 937, (a NFP public Co limited by guarantee). The sum of the member’s guarantee is $10.00.NameThis field is for validation purposes and should be left unchanged.