Membership – Renewal Update your details A year has gone by and as the fintech world changes so rapidly we need to update our details on your organisation. Have you grown? pivoted your business? expanded internationally? FinTech Australia would like to understand your evolving business to represent your membership needs better. If you haven't filled this form in the past or if you have changed, please update any changes to your information on the form below...Membership Type*StartupCorporateStartup Membership Type by Company size (number of full time employees)*Please select the membership type based on your new invoiceFounder(s) only, 0 FTEs ($275)Under 5 FTEs ($1,100)5 to 15 FTEs ($3,300)16 to 30 FTEs ($5,500)30+ FTEs ($11,000)Corporate Membership Type by Company size (number of full time employees)*Please select the membership type based on your new invoiceSelf-employed / Principals only ($550)Under 30 FTEs ($5,500)30+ FTEs ($16,500)Name*CEO/Founder's name if startup First Last Preferred Job TitleEmail* This is be our primary contact and will receive the membership invoice, member exclusive newsletters and important communicationsCompany name*Please use full trading namePlease list any other Co FoundersInclude full name; email address; phone numberHave you moved location in the last year?*YesNoOffice Phone NumberAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country If it has changedCompany URL Company Twitter HandleWill be used to tag your company in postsCompany Facebook URL Company Linkedin Profile NameCompany DescriptionPlease refill this information if it has changed. This may be used for promotional purposes 100 wordsMicro PitchWhat do you do? (in under ten words)Best person to contact for business development opportunities?Include full name; email address; phone numberWhat kind of FinTech company are you? (choose up to 3)Member characterisation will be aligned with the ecosystem map. Wealth and investment Asset management and trading Digital/Crypto currencies and exchanges Lending Payments, wallets and supply chain Insurtech Real estate tech HR tech Regtech Identity, security and privacy Incubator/co-working Accelerator/venture capital Data, analytics and information management Business tools Hardware and wearables Challenger/neo bank Marketplace-style or peer-to-peer solution Crowdfunding/fractionalised investing Blockchain/distributed ledger solution Other (please specify) Other - Please describe belowOverseas Market Expansion InterestWe'll use this to contact you with region-specific opportunities. Please check all that apply to you in the next 12 months. Africa Canada China Germany Hong Kong Indonesia Ireland Middle East New Zealand Singapore South America United Kingdom United States Other (please specify) Other Country - Please specify hereDisclaimer*By Submitting this form you agree that all details supplied are correct. You will also receive our member exclusive newsletters. Please note - if you do not meet the requirements of the category selected or if your circumstances change FinTech Australia will get in touch to discuss updating your application. I Agree Thank you for updating us with your details! We look forward to continuing to represent you to build a collaborative and healthy fintech ecosystem! This iframe contains the logic required to handle Ajax powered Gravity Forms.