Online Application

To become a member of the PRHI, individuals, groups and organisations agree to work within the
vision, functions and principles of the Interagency. These are expressed in the Interagency’s Terms of Reference. Click here to be directed to the Terms of Reference page of this website.

For your membership to be processed, please complete the following details. The names of groups
and organisations will be included on the list of members on the Interagency’s website. The names
of individuals will not be, unless requested by the individual.

Where available, we will also seek to include a website address for your organisation/group or a
contact number, for people to find out more about you. As the website is also a site where advice
is provided on how to support the work of the Interagency and members, we also ask for details on
whether you take in volunteers and accept donations. This information will be included next to your
organisation/group’s name on the PRHI website.

To encourage broader awareness and sustainability of involvement in the Interagency, we ask that
managers of groups/units/organisations sign this form on behalf of the organisation.

Only one membership form needs to completed for each service/organisation, regardless of how
many representatives attend.

1. Name of Organisation/Group or Individual (if a consumer representative):

Contact details for Representative/s (person/s likely to attend Interagency meetings) (This will not be included on the PRHI website, but for communication purposes within the Interagency):

Name:

Position:

Phone:

Email:

Other Contacts:

2. Website Address of Organisation/Group:

3. Contact Detials for PRHI website, if no website address:

4. Is your organisation / group interested in having members of the public contact you to volunteer?

yes

No

5. Does your organisation accepting money donations?

yes

No

6. Does your organisation accept non-financial donations? (e.g. household items)

yes

No