Professional Membership

Membership* (required)

Community/Not for ProfitFor Profit/Government

Name of Organisation * (required)

ABN * (required)

Website * (required)

Address * (required)

Suburb * (required)

Postcode* (required)

Phone* (required)

Contact for operational/policy matters

First name* (required)

Last name* (required)

Position* (required)

Email* (required)

Contact for other correspondence

First name* (required)

Last name* (required)

Position* (required)

Email* (required)

Briefly describe your organisation's activities.

Does your organization provide palliative care services?

YesNo

Reason for joining PC ACT (can choose more than one)

Access to information and resourcesOpportunity to influence and contribute to sectorSupport for PC ACT as a charitable organisationSupport for PC ACT to be a strong voice for palliative care in the ACTRaise profile and image of our organizationNetworking opportunitiesProfessional development

PAYMENT DETAILS

Direct Deposit (Bank Details will be emailed to you)I have sent my cheque made out to Palliative Care ACT to Tom Elvin Centre, 5 Flemington Rd, Lyneham ACT 2602.

My organization requires a Tax invoice before we can make payment