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New Membership

Membership Application Form

Welcome to the Public Health Association of Australia.
To successfully apply for a membership please complete all compulsory fields within the provided application form, these are marked with a red asterisk *.

PHAA Membership/Information Form (PDF)

Hons:

Title: *

Name: *

Surname: *

Mailing Address:*

City/Suburb:

State:

Postcode:

Country:

Phone (include area code):

Additional Phone (include area code):

Fax:

Post Nominals:

* If completing a corporate registration please complete the following two fields.

Business Name:

The nominated representative is the primary contact responsible for the corporate membership registration

Nominated Representative:

Please enter your desired username and password. These can be any combination of a minimum of eight characters. Your username and password will allow you to administer your account, pay registration fees and access the other members' features of the website.

Your Username:*

Your Password:*

Retype Your Password:*

Email:*

* If you do not have an email address you will not be able to complete your application online.

Gender:

Persons who identify as being or Aboriginal and/or Torres Strait Islander descent please select this box

Employer:

Occupation:

To insert your occupation hover the mouse over the blue Occupation button. From there hover the mouse cursor over the category of occupation. Click on desired occupation to select.

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Membership (except for student category) period is for financial year (1 July to 30 June).

Your personal information is only used for the purposes of providing the membership service offered through this website. As part of this membership service we will contact members periodically via email for the purposes of notifying members of upcoming conferences and events, jobs, and Public Health Association of Australia announcements.

By submitting your application you agree to be contacted by the Public Health Association of Australia periodically via email.

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