Affiliates Change of Details Form

Please complete and submit this form if any of your address details change. The form contains fields for all the general information the ACT holds on its Affiliates. We would be very grateful if you could fill out any fields where your information may have changed since you last informed us of your details.

Affiliate details will be amended in the electronic version on a monthly basis.

Effective date of change if not immediate
Salutation
First Name(s):
Family Name:
Affiliate No. if known:
Company Details
If you are unemployed or have left the company please tick here
Job Title
Area of Work
Type of Company
Industry
Company Name:
Company Office Address:
Postcode:
Country:
Office Switchboard:
Direct Office Tel:
Direct Office Fax:
Direct Office Email:
Company Turnover:
Parent Company Name:
Parent Company Listing:
(if other listed please state country)
Reporting Standard
Personal Details
Home Address:
Postcode:
Country:
Home Tel:
Home Fax:
Mobile Tel:
Home Email:
Invoicing Details
Invoice Address:
Postcode:
Country:
All correspondence should be mailed to:	My company address My home Address
DATA PROTECTION: The information you provide will be used only to update your details and will not be used for marketing purposes.