EntWine Australia Preliminary Membership Form - Vineyard

Please note: This form should be filled out by vineyard operators only and should take into account one vineyard site only (sites can be multiple vineyards if managed as one business in close proximity).

You must be able to answer “Yes” to questions 1 & 11 before submitting this form

EntWine Australia Indicators

1. Are you familiar with the EntWine Australia Indicators and have you begun recording data for the current financial year?	Yes
If available, please provide indicator data from the previous financial year below
2. Tonnes of Grapes Produced	(T)
3. Area Under Vine (Excluding Headlands)	(Ha)
4. Total Electricity Use	(kWh)
5. Total Water Use	(ML)
6. Total Nitrogen Applied	(Kg)
7. Total Unleaded Petrol Use	(L)
8. Total Diesel Use (Excluding Biodiesel)	(L)
9. Total LPG Use	(L)
10. Financial Year of Data Collection

Approved EntWine Australia Certification

11. Do you understand the Environmental Certification requirements for EntWine Australia, and have you identified potential certification schemes?	Yes
12. What certification scheme does your company intend to become certified to?

EntWine Australia Fees

Vineyard operators (growers only):

$110.00 (GST inc.)

Vineyard Details

Company Name:
Vineyard Name:
State:		Vineyard GI Region:

Contact Details

First Name:		Last Name:
Postal Address:
Suburb/Town:		Postcode:
State:		Phone No:
Email Address:		ABN:

Declaration

I declare that the above information is true and accurate to the best of my knowledge.

After submitting this completed form you will be redirected to our online payment facility to pay the EntWine Australia membership fee to WFA. Operators using alternate approved equivalent schemes for certification will also need to provide proof of certification to the WFA. Your membership will be processed in due course and you will be entered onto the EntWine Australia online register.