Membership Application Form - Individual Representative

Western Victoria Primary Health Network Limited

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I wish to apply for membership of Western Victoria Primary Health Network Limited. I understand that the Organisation is governed by a Constitution and that membership is free. I understand the implications of being a Company Member as described in the Constitution, and undertake to inform the Company if my Member eligibility criteria changes. I am committed to working in an integrated primary care system in the Western Victoria region.

To view the constitution please click here.

Membership category



Please note: All Applications for Membership must be considered by the Board of Directors. If your application is successful, you will be advised the outcome following the relevant Board meeting.