Company Membership Application Form

Local Government Area

I would like to apply as a member for the following local government area, in which I live, work or study:

BrimbankHobsons BayWyndhamMeltonother Western suburbs

Personal details


Why do you want to become a member?

Qualifications and Experience

Do you have any formal qualifications, please list. What is your related experience?

Background and Interests

Tell us a bit about your background and interests:

Conflict of Interest

Please disclose any potential conflict of interest:

Terms and Conditions

  • I confirm that I am over 18 years of age.
  • I understand that the Board of IPC Health will decide whether or not an applicant may become a member. The Board has absolute discretion and is not required to give a reason for acceptance or rejection of any applications.
  • I understand that if my application is successful, upon notification, I will be required to pay a $10 annual subscription fee.

I accept these terms.

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Your Company Membership Application Form has been submitted. You will be contacted via email once your application has been processed.
Thank you from the team at IPC Health.
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