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Individual Membership Form

The Individual named below hereby applies for Membership of the SNHN Ltd (Sydney North Health Network) pursuant to clause 5 of the constitution1.

Individual

The individual's aims/objectives are compatible with the objects of SNHN and we agree to be bound by the constitution governing SNHN.

Full name:
Profession:
Business / Organisation:
Qualification:
Do you have a AHPRA Registration Number:
AHPRA Registration Number:
Other registration or membership details:
Preferred Address:
Business Address (if different):
Phone Number:
Email Address:
SNHN staff member that referred you:

Communication

The SNHN preferred form of communication is via email. Formal notice of events such as the AGM may be issued by hard copy.
Would you prefer to receive formal communication by post to your business address?
Please send communications by post

Special Interests:

Languages Spoken:

Please summarise your interest in primary health care in the Sydney North region:

Applicant Consent
I have read the Consent Declaration below: I have read the Consent Declaration below.
As a member of Sydney North Health Network, I agree to accept and abide by the terms and conditions of the Company Constitution1: As a member of Sydney North Health Network, I agree to accept and abide by the terms and conditions of the Company Constitution.
Consent Declaration:

Sydney North Health Network collects personal information about members, necessary for managing the work of the Company and related programs. Such personal details will be handled by the Company staff in accordance with the Privacy and Confidentiality Procedure and Commonwealth and State privacy laws – Commonwealth Privacy Act (1988) www.privacy.gov.au.


1SNPHN Ltd Constitution is available on the SNHN website.

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