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email@ahspo.com.au
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 MEMBERSHIP
I wish to become a  Member of the above Association and in the event of my admission, I agree to be bound by the Rules of the Association for the period of my membership.
APPLICANT'S DETAILS
Name Christian Name Surname
Employer's Name
Present Position
  
ADDRESS
Mailing Address
 
Suburb State Post Code

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

PAYMENT DETAILS
  • Membership Year: 2010
  • Current Membership rate for Full, Associate & Affiliate Members is $60.00
  • Payment of $70.00 comprising your 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, AHSPO Badge 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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