Platinum $3150 Bronze $1050 Gold $1815 Cyber Support $810 Silver $1385 *Price excludes GST

Company Name: (As to appear on Membership Certificate)
This information is used to assist HDAA help you make the most of your membership. For more information please call Iain on 1300 130 447
Industry Type:
No. of 1st Level Support Staff:
No. of 2nd Level Support Staff:
No. of Customers Supported:
Name your Help Desk Software:	In-house Tool    No Tool
Is your Help Desk:	Centralised Distributed
Type of Support:	IT   Other
PABX	Make: Model:
ACD	Make: Model:
IVR in use	Yes    No
Has the organisation adopted ITIL®?	Yes    No

Delegate 1
Title:	(Dr, Mr, Mrs, Ms etc)
First Name:
Last Name:
Position Held :
Telephone:
Fax:
Email Address:
Street Address:
City:
State:
Post Code:
Country:
Postal Address:
City:
State:
Post Code:
Country:

---

Delegate 2
Title:	(Dr, Mr, Mrs, Ms etc)
First Name:
Last Name:
Position Held:
Telephone:
Email Address:
Street Address:
City:
State:
Post Code:
Country:
Postal Address:
City:
State:
Post Code:
Country:

---

Delegate 3
Title:	(Dr, Mr, Mrs, Ms etc)
First Name:
Last Name:
Position Held:
Telephone:
Email Address:
Street Address:
City:
State:
Post Code:
Country:
Postal Address:
City:
State:
Post Code:
Country:

---

Delegate 4
Title:	(Dr, Mr, Mrs, Ms etc)
First Name:
Last Name:
Position Held:
Telephone:
Email Address:
Street Address:
City:
State:
Post Code:
Country:
Postal Address:
City:
State:
Post Code:
Country:

---

Please Contact Me for Credit Card Payment Details       (Merchant Fees Apply: 1.48% Mastercard & Visa, 2.50% American Express)
Please Invoice Me - Purchase Order #(if applicable):
Enter the code you see in the image into text box:

Download A Printable Membership Application Form


ITIL^® is a Registered Trade Mark of the Office of Government Commerce in the United Kingdom and other countries