Organisation: Name of Organisation representative: Position: Postal Address: Town: Post Code: Phone: Mobile: Type of service (community health service, hospital, primary school etc.): Priority areas: (from the options below please identify all of the areas your organisation works in) Family violence Health Planning Partnerships prevention Service Coordination Prevention of alcohol Health Literacy and referrals and other drug use Client and Early Intervention Integrated Care Community Empowerment Healthy Eating Physical activity Social inclusion Consumption of Mental Health Promotion Social Marketing Water Early Years Active Ageing Food Security Sexual and Healthy, active Regional Collaboration reproductive health ageing Other (please specify) Level 2- associate Level 1- full member member Do you agree to the terms for level 1 Do you agree to members outlined in attend a minimum of the Partnership 75% of Partnership Information Forums? Which level of membership are document? you applying for? Do you agree to attend all Partnership Forums or send an organisational delegate?
Organisation: Name of Organisation representative: Position: Postal Address: Town: Post Code: Phone: Mobile: Type of service (community health service, hospital, primary school etc.): Priority areas: (from the options below please identify all of the areas your organisation works in) Health Planning Partnerships Family violence prevention Health Literacy Service Coordination and referrals Prevention of alcohol and other drug use Early Intervention Integrated Care Client and Community Empowerment Healthy Eating Physical activity Social inclusion Mental Health Promotion Social Marketing Consumption of Water Early Years Active Ageing Food Security Regional Collaboration Sexual and reproductive health Healthy, active ageing Other (please specify) Which level of membership are you applying for? Level 1- full member Level 2- associate member Do you agree to the terms for level 1 members outlined in the Partnership Information document? Do you agree to attend a minimum of 75% of Partnership Forums? Do you agree to attend all Partnership Forums or send an organisational delegate?