Membership Application Applicant Details First Name: Last Name: Enter Last Name x Contact Number: Email: Membership Details Employer of Labour: The Employer of Labour is the entity that employs staff and is legally the AHA NSW Member; this can be a corporation, partnership or sole trader. Employer of Labour typePlease select... Corporation Partnership Sole Trader Freehold Owner: ABN: Lessee (if applicable): Licence Number: Type of Licence:Please select... Hotel Liquor Licence Small Bar Licence On-Premises Licence General Bar Licence Other Nominated Person Details This is the person representing the Employer of Labour. This person acts as the representative of the AHA Member.The Nominated person has full access to all AHA NSW member resources including Industrial relations advice and member portal access.This person is eligible to nominate and vote in election of Delegates in an election year. Delegates are the representative of the sub branch and sit on the AHA NSW Council. First Name: Last Name: Mailing Street: Mailing City: Mailing State:Please select... ACT NSW NT QLD SA TAS VIC WA Mailing Postcode: Email (Primary): Mobile Number: Venue Details Venue Name: Venue Phone Number: Trading Hours: Licensee: Website: Is the Venue part of a group ? (A group must consist of three or more hotels)YesNo Hotel Group Name: Venue Address Details Venue Street: Venue City: Venue State:Please select... NSW VIC ACT QLD WA SA TAS NT Venue Postcode: Venue postal details differ from the above Venue Postal Details Venue Shipping Street: Venue Shipping City: Venue Shipping State:Please select... ACT NSW NT QLD SA TAS VIC WA Venue Mailing Postcode: Facilities Venue has Gaming MachinesYesNo Number of Poker Machines: Number of Gaming Rooms: MVSE Contact Details This is the person responsible in a venue or group's head office for administering the individual sites MVSE logins, users and reporting. SalutationPlease select... Mr Mrs Miss Ms First Name Last Name Mobile Number This will be used for two-factor authentication. Email Address This is the email address self-exclusion notifications are sent to. TAB:YesNo KENO:YesNo Foxtel:YesNo Sky Channel:YesNo Bottleshop:YesNo Venue has Accommodation:YesNo Number of Rooms: Workers compensation provider: Workers Compensation Expiry Date: Division:Please select... General Motel Off Licence Submitting on behalf of Date Privacy and Data ConsentThis 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. For further information, please email [email protected] or phone the membership team on (02) 8218 1838
