ADOHTA Life Members

Dear Life Member

ADOHTA National Council has identified that significant work needs to be done in collating and recording ADOHTA's rich history.

As an ADOHTA Life member, we would really appreciate if you could complete the online form outlining your involvement with ADOHTA. This is the start of a strategy to create electronic records of ADOHTA's achievements and ensure our past continues to be reflected in our future. We will archive this information and with your permission publish some of it on our website.

Yours sincerely,

Dr Nicole Stormon

ADOHTA President

Name

First Name Last Name

Email

example@example.com

Mobile

Area Code Mobile Number

Year Life Membership Awarded?

e.g. 2014

Positions held within an ADOHTA Branch/es (Including Dates)?

2001-2004 VIC President

Positions held within ADOHTA National Council (Including Dates)?

2014-2016 WA Representative

Most significant change within the profession during your involvement with ADOHTA?

Most memorable ADOHTA Moment?

Provide a brief outline of your career and career achievements?

Provide any other information that is important to ADOHTA's history?

Provide an image of yourself (head shot preferred)

I consent to ADOHTA publishing this information on the ADOHTA website. *

Yes No

image: Freepik.com

ADOHTA LIFE MEMBERS