Share Application Leave this field empty Applicant type Individual Partnership Incorporated company Applicant details For partnerships, enter the representative below and list all partners in the field that appears. For companies, enter the company representative below and provide the company name and ABN. Surname * Given names * Company name ABN Full names of all partners * One name per line. Address Residential address * Postcode * Shire / Farm number Postal address is the same as residential Postal address * Postal postcode * Contact details Telephone Mobile Email * Shareholding This online application is for the standard 50-share shareholding. For larger applications, please contact head office. 50 shares $100.00 Total payable today: $100.00 Declarations I HEREBY APPLY to be admitted as a member of Genetics Australia Co-Operative Limited and to be allotted the number of shares selected above at $2.00 each, payable with this application. I am able to meet the Active Membership requirements of the Co-operative, namely purchase Genetics Australia products or services to the value of $1,000.00 or more over a 12 month period. If this application is approved and the shares are allotted to me, I agree to be bound by the Rules of the Co-operative in accordance with the Co-operatives Act 1996. Electronic signature Typing your full name below acts as your electronic signature for this application. We record the date, time, and your IP address for audit purposes (Electronic Transactions Act 1999). Your full name (as electronic signature) * Date: 22 May 2026 Continue to payment → You'll be redirected to Stripe's secure payment page. We never see your card details.
