Rotarians for Family Health & AIDS Prevention Health Heroes Registration
RFHA RAG Membership Form (payment not required to become a member)

By completing this form you will be recognised as a Health Hero on our RFHA Inc website, and included in communications throughout the year on key topics around the Health Days!
Email *
First Name *
Last Name *
Company
Title
Address Line 1
Address Line 2
City
Region
Postal Code
Country
Cell Phone
District
Rotarian
Clear selection
Rotary Club
A copy of your responses will be emailed to the address you provided.
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