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TAX INVOICE
ABN 82 958 634 724
AHSPO Inc is not registered to collect GST
Therefore AHSPO Membership Fees do not include GST
APPLICATION FOR CORPORATE MEMBERSHIP
Wishes to become a Corporate Member of the above Association and in the event of its admission, agrees to be bound by the Rules of the Association for the time being in force. The nominee below will represent this company:
1st REPRESENTATIVE'S DETAILS
Title Christian Name Surname
Present Position
Mobile Phone
2nd REPRESENTATIVE'S DETAILS
Title Christian Name Surname
Present Position
Mobile Phone

COMPANY ADDRESS
Building Name / Number
Street
Suburb State Post Code
 

CONTACT DETAILS
Company Phone
Fax
Email
Name of Nominating AHSPO Member
[ Include AHSPO Member Number]
   

PAYMENT DETAILS
  • Membership Year: 2010
  • Current Membership rate for Corporate Membership is $100.00
  • Payment of $110.00 comprising 1st year membership & nomination fee as per rule 5(1), must be received at time of nomination (refer payment method).
  • If approved, you will be sent a Certificate of Membership, and copies of the AHSPO Constitution, Code of Ethics and Discrimination & Harassment Policy.
Type of Membership Applying for
Payment Option
Credit Card Details
Note: Only Visa, Bancard & MasterCard are accepted

 

FURTHER INFORMATION

Please contact:

Aldo Santo
AHSPO Membership Officer

Postal Address:
C/- Supply Dept
Wonthaggi Hospital
Graham St
Wonthaggi, Vic 3995

Tel: 03 567 13160
E-Mail: aldo.santo@bcrh.com.au
Fax: 03 567 133 69


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