Membership Form - Updated May 2024

First Nations Eye Health Alliance Limited

Membership and Friendship Application Form
Name

First NameLast Name
Contact Details

Email Phone
Organisational details (if applicable)

Organisation nameABN
Job Role (optional)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I identify as:

Other
Please specify your Mob if you identify as an Aboriginal and/or Torres Strait Islander of Australia.
Please indicate which type of membership you would like to apply for:
*Please note GST is to be applied to the invoiced amount

** Please ensure you have your organisations approval to process this request.
If type of membership selected has been made for an Associate Member from an Aboriginal and/or Torres Strait Islander community-controlled organisation, kindly confirm that the organisation has approved you as their representative.
Signature
Date

MonthDayYear
Date
Next steps: All membership and friendship applications are sent to FNEHA Board directors for endorsement. Once endorsed, you will be sent a confirmation email and invoice (if applicable) to pay for your membership. FNEHA Board meets every 6-8 weeks.

If you have any questions or concerns, please contact us at heyyoumob@fneha.com.au or our office number 02 4677 7012. The information in this confidential and subject to the privacy notice on our website https://fneha.com.au/website-privacy-notice.
By clicking submit, you declare all information on this form to be true.
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First Nations Eye Health Alliance Limited