Allied Health Assistants' National Association Ltd

Organisation Name

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Region/s my organisation operates in (select all that apply):

Details of my organisation (select all that apply):

International organisation - please specify the country in which your organisation's head office is located

How many full time equivalent Allied Health Assistants does your organisation employ or contract?

None.

Less than 10.

10-49.

50 or more.

Please provide a copy of your mission statement or similar.

Organisation Member Declaration. By submitting this application, I declare (all must be ticked):

That the contents of and attachments to this application are accurate and not misleading

That I agree to the terms of the Privacy Statement provided in the important information on the previous page

That I believe this application and the evidence provided supports eligibility for AHANA membership

That I will inform AHANA within 14 days if I become aware of any issue affecting eligibility for membership

That the I/we (the applicant/organisation) will comply with all relevant AHANA by-laws and policy requirements

Fees Due

Membership Fee:	complete home address to see fee

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NOTE: A surcharge of 1.864% is added to all Credit Card transactions.

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Founding Organisation