Health and Community Services Union

Membership Form

To become a member of the Health and Community Services Union (HACSU) you can download an application for and send it to PO Box 206, Carlton, VIC, 3053.

Click here to download a membership form.

Alternatively you can fill out the form over the page and we will send you a membership pack.

Please provide full name as it appears on your Tax Return

Title
Last Name:
Given Names:
Preferred Given Name:
Date of Birth:
Home Address:

Suburb / Town:
Post Code:
Phone (Home):
Phone (Work):
Phone (Mobile):
E-mail Address [home]:
E-mail Address [work]:
Name of Employer:
Employer Address:

Suburb / Town:
Post Code:
Employer Phone:
Employer Fax:
Job Classification & Level (RPN 3; SOC2; DDSOC2, etc):
Hours:	(if part time) specify hours: hrs per fortnight

I wish to become a member of the Health and Community Services Union, please send me the application forms:

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