Become an UHIA member - Expression of Interest
Please fill out the following information.
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mailing Address
*
Street Address
Street Address Line 2
Suburb
Postal Code
Please select the annual membership type that you wish to enrol
*
Individual - $30
Family - $50
Volunteer
Additional family member (aged 16 years or above)
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Interests
Professional development
Health and Fitness
Environment
Arts and Culture
Youth activities
Senior activities
Religious activities
Social Get togethers
Other
Back
Next
Is there a specific role you’d be interested in taking on within the organization?
e.g. Events Manager/Co-ordinator, Administrator
How would you prefer to hear from us
*
Email
SMS
Whatsapp Group
Privacy requirement
*
I agree for my details to be part of an available database, eg: sponsors, WhatsApp group etc
No, I do not wish for my details to be available to anyone else, other than the executive committee.
Please verify that you are human
*
Submit
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