Membershipexlicenseefreeholdaffiliate Membership Application First Name Last Name Business Name Address Detail Street Suburb StatePlease select... NSW VIC QLD ACT NT WA TAS SA Postcode My postal address is different to the above Postal Address Details Street Suburb StatePlease select... NSW VIC QLD ACT NT WA TAS SA Postcode Phone Number Mobile Number Email Address Further Industry Information (previous hotels and positions) Further Industry Information (hotels which you are the Freehold Owner of) Please state your interest in or connection with the hospitality or hotel industry Declaration Date Privacy and Data Consent This information is collected by AHA NSW to facilitate the provision of a product or service. Failure to provide this information to AHA NSW is likely to prevent AHA NSW from being able to offer you the product or service. Should you wish to, you can access the information you provide to AHA NSW by contacting the AHA NSW. AHA NSW may from time to time use external service providers but will not disclose personal information you provide to any other organisations or individuals, unless required or authorised by law to do so or unless you consent to the disclosure. AHA NSW does not generally provide personal information to overseas parties. If you would like to contact us or lodge a complaint please refer to the AHA NSW's Privacy Policy for further details. You acknowledge that the AHA NSW requires access to current data in order to effectively represent, and advocate on behalf of the industry and therefore upon payment of the annual subscription fee, you consent to the Independent Liquor and Gaming Authority (or other applicable Government Agency) releasing the necessary gaming machine revenue, profit and tax information to AHA NSW for the purpose of compiling industry statistics and other internal purposes relevant to the provision of services to you by the AHA NSW. This information will not be made public by AHA NSW. reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA. Contact Information
