Associate Membership Application

DO NOT USE THIS FORM TO RENEW YOUR MEMBERSHIP

This level of membership is aimed at people with a professional interest such as managers in occupational health and safety, as well as those working in technical and service areas in occupational health and hygiene.

Are you an existing member?

New AIOH Members are subject to a $30 entry fee, which will be added to your cart. Note Cart will update with total Price including GST

Title

Firstname

Surname

*Please note that Yahoo email addresses will direct AIOH emails to Spam. Please check your Junk Mail and add @aioh.org.au to your safe users list.

Date of Birth

Gender

Mobile

Home Postcode

Industry Sector

Accommodation & Food Services Administrative & Support Services Agriculture Arts & Recreational Services Construction Education & Training Electricity Finance & Insurance Services Forestry & Fishing Gas Healthcare & Social Assistance Hiring & Real Estate Services Information, Media & Telecommunications Mining Manufacturing Mould Postal & Warehousing Professional Public Administration & Safety Retail Trade Rental Scientific & Technical Services Transport Water & Waste Services Wholesale Trade Other Services

I agree to allow the AIOH State Liaison Officer (SLO) to access my contact details.

Yes

Would you like to network and find out what is happening in your State?

Company Name

Work Street Address

Work Address Suburb

Work State

Work Country

Work Postcode

Work Phone

Home Street Address

Home Suburb

Home State

Home State if Other

Home Country

How did you hear about the AIOH

Referred by Colleague/Friend*

Online Google Search

Social Media - LinkedIn

Other

If you were referred to the AIOH by a friend, Colleague or Other, please provide details or name.

I agree to have my details saved

If you are unable to submit the form:

You may already be a member of the AIOH in the database, in which case you need to login
Your personal details are already registered on the AIOH database
Please check that all required fields marked with an asterix have been completed, and try again.

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