WVPHN Membership Application - Local Hospital Network | Western Victoria Primary Health Network

Your details
Name*
Prefix First Last
Job title
Please check box*
- I am a designated individual of the Local Hospital Network (LHN)
Please provide a letter signed by the representative LHN Chair or CEO, endorsing this application*
Accepted file types: doc, docx, pdf, Max. file size: 128 MB.
Address*
City*
Postcode*
State*
Contact phone number*
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Email*
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Local Hospital Network details
Local hospital network*
Acknowledgement

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.
Do you agree to the above?*
- Yes, I agree

Last modified: 15 May, 2020

WVPHN Membership Application – Local Hospital Network