SA Cardiovascular Research Network                              Application Form             

The Power of Collaboration 

Conditions of Membership
  • Data provided in this form will be used by the CVRN to facilitate communication and collaboration among our members.
  • Only data marked with * will be shared with members.
  • Data captured will be managed by the Heart Foundation.
  • Please refer to the Privacy Statement on the last page of this form for details of data management.

Please fill in the following form. Fields marked with an asterisk (*) are mandatory. We are gathering your information so that we can better understand what would benefit you as a member and in order to be able to communicate with you on topics relevant to the SA CVRN. See below for full Privacy Statement.

Personal Information
















Research
Career Stage

Research Area

Research
Cardiovascular Disease and Condition


Research Type - Expertise and Activity*














Competitive Research Funding
Current competitive funding - grants and fellowships from Australian and International agencies





Clinical Trials


Trial Details



Patient/Consumers


Models of Disease



Datasets





Research Infrastructure/Expertise/Facilities


Network




Information Management

Privacy Statement


Your Personal Information is being or has been collected by the National Heart Foundation of Australia ABN 98 008 419 761 (Heart Foundation, we, us, our) to facilitate services requested by you and /or to keep you informed about Heart Foundation related activities. We respect your privacy and embrace the principles contained in the Privacy Act. We may contact you in the future for the promotion of heart health messages and programs, research, fundraising purposes and invitations to events. If you attend our events you may be photographed or filmed and images &/or audio may be used in various mediums to promote the Heart Foundation. Please tell event staff if you do not wish to be photographed or filmed. Personal details may be provided to third parties where required by law or for the purpose of facilitating services contracted by us, in so doing your personal information may be disclosed to overseas recipients. Further information is available in our Privacy Notice or on request. Communications from us may include mail, email, social media, SMS or telephone contact and may also include messages on behalf of event sponsors and other third parties. By providing your information to us you agree that you have provided your indefinite consent to this contact. You may withdraw consent at any time though in doing so we may not be able to provide you with services requested. The Heart Foundation will not disclose your information to any third party for their marketing purposes.


If you do not want to receive further communication from us (other than information that relates to this service) or if you have any questions about privacy please contact our Privacy Officer via GPO Box 9966 in your capital city, privacy@heartfoundation.org.au or by calling 13 11 12. Our APP privacy policy is set out in our Privacy Notice and details how you may complain about privacy issues and how we would deal with that complaint. It also explains how you can access, correct or update information we hold about you. A copy of our Privacy Notice is available at www.heartfoundation.org.au or on request. [HFPS01-190107-F]


By submitting this form I agree I have read and understood the Privacy Statement above, and agree that the data submitted will be published on the CVRN members section of the Heart Foundation website to facilitate connection and knowledge sharing among its members.


Terms and Conditions Privacy Notice
National Heart Foundation of Australia ABN 98 008 419 761