Membership Application Form - Corporate - Indigenous Allied Health Australia

Organisation Details

CorporateMemberID

Organisation Name*

Organisation Type*

Government
NGO
Aboriginal and Torres Strait Islander Organisation
Other

If other please describe organisation type*

Sector*

Health
Education
Research
Other?

If other please describe sector*

Description of Core Business*

Commitment to Indigenous Health*

Contact Details

Name*

Title First Last

Position Held

Mobile*

Work Phone

Email*

Enter Email Confirm Email

Fax

Mailing Address*

Street Address Address Line 2 Suburb State/Territory Post Code

Associate Corporate Member

ii. An organisation is eligible for membership as an Associate Member of the Company if the corporation is accepted by the Board as having a commitment to the Objects of the Company.

iii. An organisation becomes an Associate Member - Corporate upon:
A. incorporation of the Company if the organisation is listed as a Member in the Application for Registration of a Body Corporate as an Australian Company (ASIC Form 202); or
B. approval of that organisation’s application by the Board in accordance with Article 8.

Disclaimer: Please tick each box if you agree.*

I hereby declare that the information provided in this application form is true and accurate to the best of my knowledge; and
I hereby declare that I have read and will abide by the IAHA constitution
I agree to the use of my personal information for the purposes of IAHA, its secretariat and board, communicating on IAHA matters
As a member of Indigenous Allied Health Australia Ltd I agree to contribute the guarantee amount below to the property of that company if it is wound up:
I agree to provide a tax deductable donation of $200 upon membership endorsement by IAHA board of directors

Note: Subject to the Corporations Act 2001 (Cth), where the company is wound up, a present or past member is liable to contribute up to the guarantee amount to the company’s property: (i) to pay the company’s debts and liabilities and the costs, charges and expenses of the winding up; and (ii) to adjust the rights of contributories among themselves. Subject to the Corporations Act 2001 (Cth), a past member will not need to contribute: (a) in respect of a debt or liability of the company contracted after the person ceased to be a member; (b) if he, she or it was not a member at any time during the year ending on the day of the commencement of the winding up; and (c) unless it appears to the court that the present members are unable to satisfy the contributions that they are liable to make.

$ 10.00 (Please do not pay this amount, it is NOT a Membership fee.)

Full Name*

Electronic Signature

Date*