ETHF Membership Application Form

Thank you for your interest in becoming a member of East Timor Hearts Fund. This round of applications closes on Friday 26 March.

For details on membership, including eligibility criteria please click here

If you have any questions please contact info@easttimorhearts.org.au

Question Title

* Contact Details


Title

Question Title

* Full name

Question Title

* Email

Question Title

* Phone

Question Title

* Current full address

Question Title

* Country

Question Title

* Occupation

Question Title

* Current employer

Question Title

* Are you a Timorese National?

Question Title

*

Membership application


What type of membership are you applying for?

Question Title

* What is your connection to East Timor Hearts Fund?

Question Title

* Please describe how you have demonstrated support for ETHF over the last two years.

Question Title

* What is your connection / interest in heart health?

Question Title

* What is your connection / interest in Timor-Leste?

Question Title

* Please provide referee contact details. You can provide details for either:

a) Two individuals who are not members; or

b) One individual who is a current member of ETHF

Question Title

*

Attestation


By completing this membership application you agree to:

(1) support the Objects of ETHF as defined in the ETHF constitution;

(2) abide by the values of ETHF; and

(3) uphold the duties of a Member as set out in the ETHF Membership Regulation, 

(4) at all times for the duration of your Membership (if approved).

0 of 16 answered
 

T