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Member Number

Company Name

Australian Business Number (ABN)

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Last Name *

Phone Number

Email Address *

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I confirm that:

I am an eligible MFAA member or representative of an eligible MFAA member business.
The ABN provided belongs to the business I represent.
The information I have provided is true and correct.
I understand that my eligibility may be reviewed and that access to the Member Benefits Program may be suspended or cancelled if false or misleading information is provided.

I have read and agree to the above declaration.

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