Startup Membership

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Membership Type by Company size (number of full time employees)*

We recognise insurtech startups are at different stages of their growth journey. Our Startup Membership fees are tiered based on the size of your company. If you are unsure which category to sign up for please contact us.

CEO / Founder Name*

First Last

Primary Contact Person*

This person will be our primary contact and will receive the membership invoice.

Email*

Primary Contact Number*

Please list any other Co Founders

Include full name; email address

Company name*

Please use full trading name

Company URL*

Office Phone Number

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Twitter Handle

Will be used to tag your company in posts

Company Facebook URL

Company Linkedin Profile Name

Company Description

This may be used for promotional purposes 100 words

What year did your business start?*

Best person to contact for business development opportunities?

Include full name; email address; phone number

Upload Logo

Max. file size: 50 MB.

Please upload your logo to be added to the website and ecosystem map.

Overseas Market Expansion Interest

We'll use this to contact you with region-specific opportunities. Please check all that apply to you in the next 12 months.

Other Country - Please specify here

Disclaimer*

By Submitting this form you agree that all details supplied are correct and you will become a member of Insurtech Australia. You will also receive our monthly newsletters and other member communications. Please note - if you do not meet the requirements of the category selected or if your circumstances change Insurtech Australia will get in touch to discuss updating your application.

I Agree

Total

$ 0.00

Credit Card

American Express

Discover

MasterCard

Visa

Card Number 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!

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