Voting Membership

Voting Memberships are offered to not-for-profit organisations with aims and objectives which represent consumers' views and interests.

Membership Application - Voting Member

Thank you for your interest in joining the Consumers Health Forum of Australia.

Your application for Voting Membership will be reviewed by the CHF Board. Pending this review, we will process your payment as an Associate Membership. Should the CHF Board decline your application for Voting Membership, you will be offered the opportunity to have your fee refunded.

In addition to information about your organisation in the form below, we need additional information for the CHF Board with a signed declaration. Please download this form (Word doc) and email the completed information to [email protected]

Income Range *

<$250,000 - $ 100.00 (includes GST of $ 9.09)

>$250,000 - $ 500.00 (includes GST of $ 45.45)

Total Amount

Voting Member Details

Organisation Name *

Address Line 1 *

Address Line 2

Address Line 3

Town or Suburb *

State or Territory *

Postcode *

Telephone *

Email Address *

Country

About your organisation

A one sentence description that can be included on the CHF website - max 50 words

Approximate number of consumers in your network

Main Areas of Interest

Executive Officer

Title

First name

Surname

Hon

Position

Telephone

Email Address

Chairperson/President

Title

First name

Surname

Hon

Position

Telephone

Email Address

Consumer Representative Co-ordinator

Do you have a Consumer Representative co-ordinator?

Yes No

Title

First name

Surname

Hon

Telephone

Account

Please enter a Username to create an account. If you already have an account please login before completing this form.

Username *

Check Availability
Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

Contact Person

Title

First Name *

Last Name *

Hon

Only complete if your postal address is different from your organisation:

Postal Address

Address Line 2

Town or Suburb

State or Territory

Post Code

Country *

Telephone

Email *

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Territory *

Post Code *