Membership Form
First Name
Last Name
Farm/Organisation/Business Name
ABN
Email
Mobile Phone Number
Please enter your mobile number without spaces
Land Line Phone Number
Please enter your land line number without spaces
Who is paying the Levy
Please select...
Company
I am
Other
ACN
Please specify who is paying the levy
Are you a Share farmer or Owner?
Please select...
Share farmer
Owner
Percentage of Levy
Who do you supply milk to?
.
For more information please click
https://www.dairyaustralia.com.au/about-us/membership
Postal Address
Street/Road
Town/City
State
Please select...
ACT
NSW
QLD
TAS
SA
VIC
WA
NZ
Post Code
.
Is the farm location address the same as the postal address?
Yes
No
.
Farm Location Address
Street/Road
Town/City
State
Please select...
ACT
NSW
QLD
TAS
SA
VIC
WA
NZ
Post Code
.
Additional Members
Additional Member First Name
Additional Member Last Name
The information provided will be used in accordance with our
privacy policy
Contact Information