Membership

Update your details

ONLY fill in the field/s that needs updating.

Fields marked with a * must be completed.

Receipt Details

Fill in your email address to receive a receipt when the QNU receives your change of details form. If you choose not to fill in your email address you will not receive confirmation that your form was submitted correctly.

Email Address

Personal Details

Membership Number *
Date of Birth *
Surname *
Given Names *

Address, Telephone & Email

Postal Address (If different to permanent Address below)
Permanent Address
Telephone Number (work)
Telephone Number (home)
Telephone Number (mobile)
Email Address (home)
Email Address (work)

Workplace Details

Job Title eg Clinical Nurse, DON, NUM, etc.
Workplace (Full name of hospital or health agency; if an annexe attached to a hospital, e.g. aged care or psychiatric, please state both)
Employer (Name of hospital, nursing home or domiciliary centre etc.)
Name of second employer (If applicable)

Membership Details

Classification
Employment status
Average hours worked per fortnight (full fees apply if you work more than 48 hours per fortnight)
Part-time/casual declaration	I hereby declare that I work 48 hours or less per fortnight as a casual or part-time employee and agree to notify the Union should there be an increase in these hours. If you work at more than one workplace please add your hours together.
Student hours worked per fortnight The full time university and TAFE student fee is only for students who do not have an RN or EN qualification

Change of Hours Date

Change of Hours Date
(What date did you change your hours worked)

Additional Information

Other comments
Any other information you would like us to know about your updated details

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