Organisation Membership

Organisation Name

Organisation acronym

Website URL

Contact Email

Send me email updates

Street

Suburb

City

State

Postcode

What type of organisation are you?

Other type of organisation (* if applicable)

Non-health groups can join as an Associate Member of the Climate and Health Alliance (CAHA). This category of membership allows all the same benefits, however Associate Membership does not allow you to vote at the Annual General Meeting.

Number of members (*If a member-based organisation)

Australian Business Number

Tell us why you want to become a member of the Climate and Health Alliance

Lead Contact Details

Lead Contact Name

Lead Contact Mobile Number

Lead Contact Work Number

Lead Contact Email

Administration Contact Details

Administration Contact Name

Administration Contact Mobile Number

Administration Contact Work Number

Administration Contact Email

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 organisation membership declaration

Organisation Membership

Email: