| Document Date: 2015-04-07 18:03:34
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Company Bank of Queensland Account / Qld Seafood Industry Assoc Inc / Mastercard / Queensland Seafood Industry Association Inc. / CSC / QSIA / / Currency USD / / / IndustryTerm insurance brokers / retail / marine safety equipment suppliers / / NaturalFeature Baffle Creek / Wonga Beach / Gulf of Carpentaria PAYMENT OPTIONS / / OperatingSystem L3 / / Organization Queensland Seafood Industry Association / PO / Affiliated Association / / Person Torres Straits / Fisher Licence / / / Position Executive Officer / Fisher / eo@qsia.com.au Executive Officer / /
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MEMBERSHIP APPLICATION FORM Name: Company: Residential Address: Postcode Postal Address: