Associate Organisational Membership (not for profit organisations)

Associate Membership (Organisational not-for-profit) is available for not-for-profit organisations that support the aims and objectives of Consumer's Health Forum of Australia

Membership Application - Associate Organisational

Thank you for your interest in joining Consumer's Health Forum of Australia.

Income Range *

<$250,000 - $ 100.00

>$250,000 - $ 500.00

Total Amount

Associate Organisational Member Details

Organisation Name *

Address Line 1 *

Address Line 2

Address Line 3

Town or Suburb *

State or Territory *

Postcode *

Telephone *

Email Address *

About your organisation

A one sentence description that can be included on the CHF website - max 50 words

Approximate number of consumers in your network

Main Areas of Interest

Consumer Representative Co-ordinator

Do you have a Consumer Representative co-ordinator?

Yes No

Title

First name

Surname

Hon

Telephone

Please enter a Username to create an account. If you already have an account please login before completing this form.

Username *

Check Availability
Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

Contact Person

Title

First Name *

Last Name *

Hon

Only complete if your postal address is different from your organisation:

Postal Address

Address Line 2

Town or Suburb

State or Territory

Post Code

Telephone

Contact Person's Email Address *

Credit Card Information

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Territory *

Post Code *

Consumers shaping health

Associate Organisational Membership (not for profit organisations)

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