Provincial Health Organisations or Regions Membership Application

This is the membership application for Provincial Health Organisation memberships. If you are applying as an individual or on behalf of a non-profit or regional or individual health care organisation, please go back and select the appropriate application.

If you have any difficulty completing the form or any questions about the membership application process, please contact


New Membership
Total Amount
Organisation Details
Number of persons employed (head counts), and number of full-time equivalent (FTE) persons employed in general and specialty hospitals. Self-employed are included.
Number of separate hospital and other care sites.
Health Care Details
Please enter a Username to create an account. If you already have an account please login before completing this form.
Primary Contact