Positive Life NSW Membership Form

Please complete the form below to become a member of Positive Life NSW.
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To apply for Full membership, you must be aged 18 years or over, and a NSW resident living with HIV; To apply for Associate membership you must be a NSW resident 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 resides inside or outside New South Wales.

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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. I understand that this is legally binding and can be used in a court of law. To accept, type your name below and click the submit button.

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 information about Positive Life NSW and all our publications. You can unsubscribe from email updates following the instructions in the email. We store your personal information in hardcopy or electronically or both. 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) 9206-2177 or 1800 245 677 (freecall).

Givenow - make a secure online donation to Positive Life NSWLocation: Suite 5.2, Level 5, 414 Elizabeth Street, Surry Hills NSW 2010
Postal: PO Box 831, Darlinghurst NSW 1300

Telephone: 02 9206 2177 or 1800 245 677 (freecall)
TTY: 131 450    Fax: 02 9211 5672

 
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