ETHF Membership Application Form

Thank you for your interest in becoming a member of East Timor Hearts Fund. 

For details on membership, including eligibility criteria please click here

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


Title(Required.)
First name(Required.)
Surname(Required.)
Email(Required.)
Phone(Required.)
Current full address(Required.)
Country(Required.)
Occupation(Required.)
Current employer(Required.)
Are you a Timorese National?(Required.)
Membership application


What type of membership are you applying for?(Required.)
What is your connection to East Timor Hearts Fund?(Required.)
Please describe how you have demonstrated support for ETHF over the last two years.(Required.)
What is your connection / interest in heart health?(Required.)
What is your connection / interest in Timor-Leste?(Required.)
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(Required.)


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).(Required.)
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