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Membership Information

Join EHA!

Personal Details

Title

First Name

Family Name

Address 1		Address 2
Suburb/City
State	Please enter your state
Postal/Zip Code
Country
Business Phone	(including area code)
Business Fax	(including area code)
Mobile Phone
E-Mail Address
Date of Birth

Membership Details
New Members

2008-2009 Membership Subscription is $290.91 + 29.09 GST = $320.00 . New Member/Associate/Affiliate applicants are entitled to pro-rata when joining.

Membership	Membership Fee
Member - Degree in Environmental Health related field	$169.70	+ $16.97 GST	= $186.67
Associate Member - Advanced Diploma, Dip., Assoc Dip., Certificate in EH related fields	$169.70	+ $16.97 GST	= $186.67
Affiliate Member - person in EH related field	$169.70	+ $16.97 GST	= $186.67
Student Member – undertaking full or part time study in EH related courses (not Certificate)	$0	+ $0.00 GST	= $0.00
Environmental Health Worker (EHW)	$50	+ $5.00 GST	= $55.00

Qualifications / Education Details

Qualifications / Current Course	Year	Tertiary Institution

Employment Details

Current Position:
Name of Employer:

Special Interest Groups

	Disaster Management	Please select your interest(s). National SIGs are shown in bold.
	Disease Control
	Environment Management
	Food Safety Management
	Healthy Settings
	Indigenous Environmental Health
	Professional Development

	Catchment Management
	Health Promotion
	Health Legislation
	Toxicology
	Waste Management	Other SIG's:

Branch Executive Officer Details
Send Application Form together with membership fee and confirmation of qualifications to the Executive Officer in your Branch.

Qld & Head Office	NSW/ACT	WA/NT
Jo Rolls PO Box 2222 Fortitude Valley BC Qld 4006	Margaret Hind PO Box 2222 Fortitude Valley BC Qld 4006	Valarie Filevski PO Box 239 Tuart Hill WA 6939

SA	VIC	TAS
Mina Labaz PO Box 168 Unley SA 5061	Bernadet Ferraro PO Box 378 Diamond Creek VIC 3089	Bernadet Ferraro GPO Box 2154 Hobart Tas 7001