Membership

Community Membership Application Form

Use this form to join Primary Care Connect as a community member.

Membership application

  • I confirm that I am over 18 years of age and I am not an employee Primary Care Connect and (please check box);
    • • I wish to apply for membership of Primary Care Connect for the 2015-2016 Financial Year.
    • • I have read the Primary Care Connect Constitution.
    • • I consent to the Constitution and agree to guarantee Primary Care Connect to the extent set out in the Constitution.
    • • I am applying as a new member of Primary Care Connect.