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:*

Aboriginal of AustraliaTorres Strait Islander of AustraliaAboriginal and Torres Strait Islander of AustraliaNon Aboriginal and/or Torres Strait IslanderOther
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:*

Full Member - Aboriginal and/or Torres Strait Islander person of Australia working in, studying or interested in eye health (Free)Associate Member - Aboriginal and/or Torres Strait Islander community-controlled organisation of Australia (Free) **Friends of FNEHA - Non-Indigenous Individual ($220 ex GST* per year)Friends of FNEHA - Non-Indigenous Organisation ($1,100 ex GST* per year)
*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.

YesNoN/A
Signature*

Clear
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

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.