Startup Membership loggedinMembership Type by Company size (number of full time employees)*We recognise FinTech Startups are at different stages of their growth journey. Our Startup Membership fees are tiered based on the size of your company. FinTech Australia will contact you once this form is received to discuss approval of your membership application.Founder(s) only, 0 FTEs ($300)Under 5 FTEs ($1,100)5 to 15 FTEs ($3,300)16 to 30 FTEs ($5,500)30+ FTEs ($11,000)FinTech Australia's constitution allows each member company to appoint up to two people who are able to exercise the rights of membership on behalf of the member company. An example is a person authorised by the member company to attend and vote at FinTech Australia General meetings. The delegates much be an officer or employee of the member company appointed by a Director/Officer of the Member company. Communications between FinTech Australia Ltd and its members pertaining to membership issues, constitutional, legal and governance matters will occur with the individuals named belowFirst Nominated DelegateName of First Nominated Delegate* First Last Job Title of First Delegate*Email of First Delegate* Member login account will be created using this email addressContact Number of First Delegate*Name of Company Director/Officer who authorises the above person to be the nominated delegate of the member company*Second Nominated DelegateName of Second Nominated Delegate First Last Job Title of Second DelegateEmail of Second Delegate Contact Number of Second DelegateName of Company Director/Officer who authorises the above person to be the nominated delegate of the member companyCompany InformationCompany name*Please use full trading nameABN (Australian Business Number)Company URL*Invoices addressed to* First Last Email for invoices* Office Phone NumberAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Company Twitter HandleWill be used to tag your company in postsCompany Facebook URL Company Linkedin Profile NameCompany DescriptionThis may be used for promotional purposes 100 wordsMicro PitchWhat do you do? (in under ten words)What year did your business start?*What 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 Total $ 0.00 Credit Card* American ExpressMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Thank you for applying to join our membership! We look forward to working with you to build a collaborative and healthy fintech ecosystem! This iframe contains the logic required to handle Ajax powered Gravity Forms.