Membership Application Form – Corporate Organisation DetailsCorporateMemberIDOrganisation 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 DetailsName* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Last Position HeldMobile*Work PhoneEmail* Enter Email Confirm Email FaxMailing Address* Street Address Address Line 2 Suburb State/Territory Post Code Associate Corporate Memberii. 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 SignatureDate* Date Format: MM slash DD slash YYYY