Postal Address: Postcode: Please enclose cheque made payable to Landscaping Victoria or complete credit card details:

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1 1 This application form should be used by landscapers who undertake structural landscaping over $5000 but are not currently licensed. Please complete the following and return to with application fee of $ copy of Business Registration Certificate. Business Name: Trading Name (if different) Registered Business Address: Postal Address: ABN: Fax: Web: Postcode: Business Registration Certificate Attached Year Business Registered: Main Focus of Business: design design + construct construct Size of Business (no. full-time employees): Contact Name: Position: Mobile: Accounts Contact Name: retains the right to accept or reject an application. Provisional subscriptions are for two years of the date of acceptance to membership. Assessment of application may take up to 8 weeks. Application Fee $ (if application is successful, an invoice for annual membership pro-rata will be sent) Please enclose cheque made payable to or complete credit card details: Card Type: Mastercard VISA Card No: Name of Card Holder: Card Expiry: / Signature: Declaration: I certify that the above information is true and correct, and I hereby agree, if accepted for membership of Landscaping Victoria, to be bound by the rules and regulations of the Association. Signature: Date: Office Use Only Application Recvd. Approved Suite 2/497 Burke Road Hawthorn East VIC 3123 T: F:

2 2 Qualifications & Training Education (relevant courses / diplomas completed) Apprenticeship Details (if applicable) (attach copy certificate) Employer: Training Institute: Employment History Year Completed Year Employer Position Domestic Builder Registration Limitations: Date Completed: Please note: f you perform structural works as part of your business, you will be expected to have your building license structural landscaper before being upgraded to full membership. Other Qualifications / Experience / Memberships Services & Skills of Business ( ) Domestic Landscape Construction Commercial Landscape Construction Garden Maintenance Landscape Design Outdoor Lighting Installation Planting / Plant Selection Project Management Ponds Fencing No: Earthworks (civil works) Turf Installation Pool Construction Paving Irrigation Installation Stonework Other (specify) Suite 2/497 Burke Road Hawthorn East VIC 3123 T: F:

3 3 Skills Assessment As part of the process to join, we request that you nominate 2 projects that you have completed in the past 2 years that best reflects the quality and breadth of your workmanship and skills. Our assessors will visit at least one of these projects. Please seek your clients permission prior to submitting their garden. Site 1: Name of Client/s Address Contact Number to arrange visit: Approx. Value of Project : $ Date Completed Your role in this project ( ) Design Irrigation Project Management Maintenance Hard Landscaping Elements (paving, retaining walls etc) Pool Construction Soft Landscaping Elements (planting, plant selection etc) Other (please state) Did you have a written contract for this project? YES NO If yes please attach a copy Office Use Only Assessment Notes Design Hard Elements Soft Elements Irrigation & Drainage Customer Service Other Comments Competent ( ) General Observations Suite 2/497 Burke Road Hawthorn East VIC 3123 T: F:

4 4 Skills Assessment As part of the process to join, we request that you nominate 2 projects that you have completed in the past 2 years that best reflects the quality and breadth of your workmanship and skills. Our assessors will visit at least one of these projects. Please seek your clients permission prior to submitting their garden. Site 1: Name of Client/s Address Contact Number to arrange visit: Approx. Value of Project : $ Date Completed Your role in this project ( ) Design Irrigation Project Management Maintenance Hard Landscaping Elements (paving, retaining walls etc) Pool Construction Soft Landscaping Elements (planting, plant selection etc) Other (please state) Did you have a written contract for this project? YES NO If yes please attach a copy Office Use Only Assessment Notes Design Hard Elements Soft Elements Irrigation & Drainage Customer Service Other Comments Competent ( ) General Observations Suite 2/497 Burke Road Hawthorn East VIC 3123 T: F:

5 5 Completing your application Once you have completed each page of this application please attach all requested documents and return to, suite 2, 497 Burke Road, Hawthorn East VIC Checklist of attachments Membership Fee (cheque or credit card details) Certicate of Business Registration Proof of qualification (indenture papers or TAFE certificate etc) Certificate of Currency Public Liability Insurance Industry Reference (LV member, hort. teacher or recognised industry professional) Name Business Contact Phone I support s application for membership of Landscaping Victoria as I believe that he /she /the business represents the values of quality of workmanship, pride in their work and professionalism in their dealings with clients, the public and their employees values that underpin the aims and objectives of the Association. Sincerely Signature of Referee. Please forward your application to. Allow 8 weeks for your application to be processed. Receipt will be acknowledged. If you have any queries or concerns please do not hesitate to contact us. As a Provisional Member you will need to participate in at least two training sessions plus pursue your Builders License (applicable only to landscape builders) and provide a business plan when seeking to upgrade to full membership. Provisional membership will not be extended beyond a two year period. Office Use Only Membership Fee Received Follow up Required: Documents Received Date Suite 2/497 Burke Road Hawthorn East VIC 3123 T: F: