Application for membership
This application is to become an:
*
Organisational member (a not for profit body or government bodies)
Associate member
My organisation is a not for profit body or government body
*
Yes
No
On acceptance into Membership, I consent to:
Back
Next
Organisational applicant details and profile
Legal name of organisation
*
Member name (if different from legal name)
Address
*
Street Address
Street Address Line 2
Suburb
State
Postcode
Phone number
*
-
Area Code
Phone Number
Mobile number
-
Area Code
Phone Number
Email
*
example@example.com
Website address
*
ABN/Australian Company Number
*
Organisational profile
*
Please include information about your main services offered and who the recipients are
Back
Next
Organisation CEO details
CEO name
*
First Name
Last Name
CEO address is the same as the organisation address
*
Yes
No
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number
*
-
Area Code
Phone Number
Mobile number
-
Area Code
Phone Number
Email
*
example@example.com
Are you the organisational representative?
*
Yes
No
Back
Next
Corporate representative details
Name
*
First Name
Last Name
Address is same as Organisation address
*
Yes
No
Address
*
Street Address
Street Address Line 2
Suburb
State
Postcode
Phone number
*
-
Area Code
Phone Number
Mobile number
-
Area Code
Phone Number
Email
*
example@example.com
Back
Next
Associate applicant
I am applying as an
*
Organisation
Individual
Legal name of applicant
*
Individual or body
Member name (if different from legal name)
Address
*
Street Address
Street Address Line 2
Suburb
State
Postcode
Phone number
*
-
Area Code
Phone Number
Mobile Number
-
Area Code
Phone Number
Email
*
example@example.com
Website
ABN/ACN
Organisational profile
*
Please include information about your main services offered and who the recipients are
Applicant profile
*
This is to assist enliven (SEHCP Inc.) to understand your range of interests
Back
Next
Associate applicant CEO details
These are the contact details enliven (SEHCP Inc.) will use for membership related details
CEO Name
*
First Name
Last Name
CEO Address is same as organisational address
*
Yes
No
Address
*
Street Address
Street Address Line 2
Suburb
State
Postcode
Phone number
*
-
Area Code
Phone Number
Mobile number
-
Area Code
Phone Number
Email
*
example@example.com
Are you the organisational representative?
*
Yes
No
Back
Next
Associate applicant representative details
These are the contact details enliven (SEHCP Inc.) will use for membership related details
Name
*
First Name
Last Name
Associate representative address is the same as organisational address
*
Yes
No
Address
*
Street Address
Street Address Line 2
Suburb
State
Postcode
Phone number
*
-
Area Code
Phone Number
Mobile number
-
Area Code
Phone Number
Email
*
example@example.com
Back
Next
Enter the message as it is shown
*
Submit
Should be Empty: