If you are resigning your VAHPA membership, please fill out this form. Your name *FirstLastMembership Number (if known)Date of Birth *Phone Number *Your email address *What is your reason for resigning? (check all that apply) *Financial difficultiesMoved interstate / overseasNo longer working as an Allied Health ProfessionalJoined professional bodyBetter indemnity deals elsewhereOn extended leave (parental leave/LSL)UnemployedRetiredDissatisfied with VAHPAPersonal reasonsNo assistance requiredOther (please specify below)Other (please specify)Please note that the VAHPA offers discounted memberships for members who are going on parental leave or having financial difficulties. Your request will be subject to approval by the Branch Committee of Management (BCOM). Please see website for details or contact VAHPA at info@vahpa.asn.au. Overall, how satisfied were you with VAHPA? *Very satisfiedSatisfiedNeither satisfied nor dissatisfiedDissatisfiedVery dissatisfiedTo assist with ongoing improvement of our services, please provide any comments or feedback you might have.NameSubmit
