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:

AboriginalTorres Strait IslanderAboriginal and Torres Strait IslanderNon Aboriginal and/or Torres Strait IslanderOther
Please indicate which type of membership you would like to apply for:

Full Member - Aboriginal and/or Torres Strait Islander individuals working in, studying or interested in eye health (Free)Associate Member - Aboriginal and/or Torres Strait Islander community-controlled organisations (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
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.
Should be Empty:

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.