Individual Membership

First Name

Last Name

Contact Email

Mobile Number

Send me email updates

Send me text message updates

Street

Suburb

City

State

Postcode

Are you a health professional?

What is your background?

What has motivated you to become a member of CAHA?

Are you willing to be publicly acknowledged as a CAHA member?

How else would you like to be involved?

Joining working groups and/or committees

As a spokesperson on climate change and health

Writing opinion pieces for media

Joining the 'Our Climate and Our Health' campaign as a climate-health champion

Assisting with CAHA's Sustainable Healthcare program

I'm happy to just support CAHA through paid membership

Other way to be involved with CAHA

Membership Declaration

Members of CAHA commit to supporting the CAHA Aims and Objectives, outlined in the CAHA Statement of Purpose, available here: http://www.caha.org.au/join

Please indicate your support below to confirm your application for membership.

I declare my support for the CAHA Statement of Purpose and agree that:

By completing this form, and paying an annual fee, I will:

(a) Be listed as a member of Friends of CAHA.
(b) Undertake to encourage others to promote action on climate change as a health issue.
(c) Undertake to reduce my environmental impact.
(d) Be willing to contribute to development and future directions of the Alliance and the issues on which it engages and informs, advocates, shares and collaborates.
(e) Be contacted with news of important events or publications.

I agree with the individual membership declaration

Individual Membership

Email: