Membership Application

Section 1. Individual membership

Surname of individual

First name of individual

Go to Section 3

Section 2. Organisational membership

Name of organisation

Please nominate a woman to represent your organisation

Section 3. All categories of membership

Address

Home phone number

Work phone number

Mobile phone number

Email address

Are you interested in becoming involved in the WHV Council and/or Task Groups?

Are you interested in receiving communications via email?

Section 4. Terms of agreement

By submitting this form I/we agree with the Statement of Purposes of Women's Health Victoria and desire to become a member of the organisation for the year ending 2008 Annual General Meeting. As a member of the Association I/we shall at all times comply with the rules of the Service.

I/we accept that Women’s Health Victoria constitution requires that my/our name, address and date of entry shall be kept in a membership register and that this is available for inspection by the members at the address of Women’s Health Victoria.

Membership is for one year effective from the day after the 2007 AGM until the next AGM in 2008.