Skip to main content
Home
About Us
Newsroom
Key Focus Areas
Contact Us
Become a member
Home
About Us
Newsroom
Key Focus Areas
Contact Us
HFA Membership Application
Online Application Form for Membership of the Health Funders Association
Online Application Form for Membership of the Health Funders Association
Type of application
(*)
Please Select One
Ordinary Member (for Schemes and Administrators)
Associated Member (for Managed Care Organisations)
Invalid Input
Organization details:
Registered name
(*)
Invalid Input
Trading Name
(*)
Please type your full name.
Registration Number
(*)
Invalid Input
Registered Address
(*)
Invalid Input
Website Address
Invalid Input
Telephone
(*)
Invalid Input
CEO / Principal Officer details
Full Name
(*)
Invalid Input
Designation
(*)
Invalid Input
Identity No.
(*)
Invalid Input
Office Telephone
(*)
Invalid Input
Mobile Telephone
(*)
Invalid Input
E-mail Address
(*)
Invalid email address.
Scheme Membership Details:
Total Number of Principal Members
(*)
Invalid Input
Total Number of Beneficiaries
(*)
Invalid Input
Declaration by head of the applicant organisation:
I declare that, to the best of my knowledge, that the information herein supplied is complete, true and correct and not misleading in any respect.
I hereby confirm that I have the necessary authority to furnish this information and to make the undertakings required herein.
I agree to comply with the rules and terms of membership as laid out in the Memorandum of Incorporation of the Health Funders Association.
Date
(*)
...
Invalid Input
Representative Full Name
(*)
Invalid Input
Your Designation
(*)
Invalid Input
I Confirm
(*)
the Declaration and Agree to the Terms and Conditions.
Invalid Input
Password for Website
(*)
Invalid Input
Verify Password
(*)
Invalid Input
(*)
Invalid Input
Submit
Reset
Application Form Download and Return
