Membership Application Form 2021 – 2022
(Membership is free but donations are welcome and valued - donations over $2.00 are tax deductible)
The Women’s Centre for Health Matters Inc. (WCHM) is a community-based organisation which works in the ACT and surrounding region to improve women’s health and wellbeing, using social research, community development and health promotion.  WCHM is managed by women, for women, is pro-choice and is funded by ACT Health.

Your Membership
WCHM encourages women, men and organisations who support the Mission, Vision and Values of WCHM to become members.  WCHM membership is free and offers a variety of benefits:
 access to regular information on current activities and to new publications and reports published by the Centre
 the chance to provide input on policies and service delivery issues which affect them or other ACT women
• invitations to all activities, launches and other WCHM functions 
• receipt of the quarterly WCHM e-bulletins and weekly newsletters 
• attendance and voting rights (individuals only) at the AGM
• the option to nominate to join the Board of Directors (individuals only)

Is this a membership renewal?         
	OR

OR	Is this a new membership?         
	
Individual Membership		Organisation Membership 	
Name			Name of Organisation		
Address 
		Organisation Rep Name		
		Address

Telephone			Telephone		
Mobile					
Email			Email		
Preferred contact method (Place   in selected box):
Telephone:                              Mobile:                                Email:    	
Preferred method to receive published WCHM reports (Place    in selected box):
Mail (hard copy):                        Email (Electronic copy):                         View on WCHM website:    	
DONATIONS
WCHM is endorsed as a health promotion charity, and donations of $2 or more are tax deductible. If you would like to support us by making a donation, you can complete the following and send us a cheque made payable to Women’s Centre for Health Matters Inc or go to our website and make a donation .
I wish to make a donation of $ ________to the Women’s Centre for Health Matters.	

Applicant Signature: __________________			Date: _________________
Your signature also indicates your agreement to support WCHM’s Mission, Vision and Values.
Please return the completed form to WCHM by:
Emailing a scanned copy to:  admin@wchm.org.au
or 
Mailing it to PO Box 385, Mawson  ACT  2607

More information about WCHM is available at:  www.wchm.org.au or contact us at admin@wchm.org.au 

WCHM Representative Signature: ______________________ (for WCHM to complete)