Individual Membership – Apply Application for Individual Membership Membership Sought * (Please Select) Affiliate Full Member (n.b. subject to assessment) Applicant Details Surname * Other Names * Preferred Name Date of Birth * Home Address * Postcode * Mobile * Telephone Personal/Home Email * Employer Details Employer Name * Employer Address * Postcode * Mobile * Office Telephone Work Email Preferred Email Address * Home (IHEA recommend due to Corp’ firewall settings/policies) Work Feedback How did you hear about IHEA? * APPLICANT’S DECLARATION Checkboxes * I agree, if admitted to the Institute of Healthcare Engineering Australia, to conform to the memorandum and articles of association and rules of the Institute. I certify that statements made by me, on this application, are correct. Attach a copy of your résumé * Drop a file here or click to upload Choose File Maximum upload size: 5MB Submit
