Join Us Individual - Southern Crossings

Individual Membership Application

Please use this form to apply for membership to our group.

"*" indicates required fields

Personal Info

Name

First Last

Email*

Mobile*

Company*

Role / Position*

Industry your company operates in*

Please list Industry if other*

Year born*

Gender

Home postcode (Aus)*

Please enter a number from 0 to 9999.

Your Linkedin URL (for inclusion in member list)*

Requirements & Interests

Your South African Connection (check all that apply)*

I was born in South Africa and moved to Australia

My parents/family are from South Africa

I do business in South Africa

I live in South Africa and am interested in coming to work in Australia

My company is interested in networking with South African business people

I work for a company with South African roots/interests

Year you moved to Australia*

Your home town / city in RSA

Your university in RSA

Business Connectivity (check all that apply)*

I am a C-Suite business executive (ie CEO/MD, CFO, CTO, CRO etc)

I am a business executive

I am a professional director/board member

I am a business owner/shareholder

I am a professional (eg lawyer, accountant, engineer etc..)

I am an investor and I meet the Australian sophisticated investor test

Please provide a short description of the business(es) you are involved in*

Please select your profession*

Please elaborate other choice for profession*

Highest degree / qualification*

What are you interested in / how can we help? (check all that apply)

I am in between roles and looking for the next thing

I am looking for investment opportunities

I want to get involved with Southern Crossings helping South Africans advance Australia

I want to get involved in mentoring others

I am interested in connecting with mentors

Other

Please list the type of role you are interested in*

Please describe the type of investment you are interested in*

Please describe how you would like to be involved (eg. be a patron, join a committee or group etc.)*

Please describe your other interests / how we can help (optional)

How did you hear about us?*

Please insert name of person

Please list other*

Declaration

Declaration*

I understand and consent to the following:

That Southern Crossings reserves the right to in its sole discretion approve, modify or cancel memberships at any time.
I will abide by the terms and conditions as published on this website from time to tome and the protocols set by Southern Crossings in relation to attending or participating in any event. I consent to my picture being taken and that it may be published by Southern Crossings as part of event updates.
I consent to my information being collected and that my details will be published on the member register and be available to other members.
Unless authorised by Southern Crossings in writing, I will not conduct any commercial, political, soliciting, promotional, performance, surveying, canvassing or demonstration activity at any event, nor collect contributions or distribute any material.

Payment

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Membership Type*

Individual Membership

Individual Membership for 1 year: $250

GST

GST: $ 0.00

Coupon

Total Cost:

Credit Card

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Individual Membership Application

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Requirements & Interests

Declaration

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