Become a Member of Positive Life NSW

Please complete the form below to become a member of Positive Life NSW.

(*) indicates a response is required

I wish to become a member of Positive Life NSW *

Yes

I agree to abide by the Constitution of Positive Life NSW at all times *

Yes

Application Details

I'm applying for *

Full Member - I am a NSW resident living with HIV, over the age of 18 years old and I am entitled to voting rights as a Positive Life Full member

Associate Member- I am affected by HIV (i.e., a partner, family member, carer, healthcare worker etc); or under the age of 18 years living with HIV (subject to the consent, where appropriate, of his or her parent or guardian), and I reside inside or outside New South Wales.

First Name *

Last Name *

Street Address *

Suburb *

Postcode *

City *

Do you consent to receive printed information in a plain unidentified envelope from Positive Life?

Yes

Home Phone

Mobile Phone

I consent to receive information electronically from Positive Life NSW (if you provide your email)

Yes

I would like to:

volunteer

I would like to:

donate

I agree to the terms of this agreement and I acknowledge that my typed name below can be used as a digital representation of my signature to that fact. To accept, type your name below and click the submit button.

Name *

I have read the Privacy/Health information statement below and consent to this information being collected and stored *

Yes

PRIVACY/HEALTH INFORMATION STATEMENT

Positive Life NSW collects your personal information in accordance with our Privacy Policy (opens in a new window). Your details are strictly confidential and only used to add you to our membership database. If you provide your email address we will send you Positive Life NSW membership information and updates related to people living with HIV in NSW. You can unsubscribe from email updates following the instructions in the email. If you unsubscribe from email, you will no longer receive any membership information from Positive Life including voting details, and Annual General Meeting (AGM) information. Access to your information is strictly limited to Positive Life NSW staff members and will not be passed on to any other organisation or individual. You can access and correct your personal health information by contacting us on (02) 8357=8386 or 1800 245 677 (freecall).

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Become a Member of Positive Life NSW

Application Details

PRIVACY/HEALTH INFORMATION STATEMENT

Positive Life NSW is an ACNC registered Australian Charity