Application for Primary Membership
  1. APPLICATION FOR PRIMARY MEMBERSHIP
  2. Primary membership is free for mental health consumers
  3. CONTACT DETAILS
  4. Your name and at least one contact address/email is required
  5. Title(*)
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  6. Please specify
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  7. First Name(*)
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  8. Surname(*)
    Please let us know your name.
  9. Address(*)
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  10. Postal Address (if different)
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  11. Email
    Please let us know your email address.
  12. Home Phone
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  13. Work Phone
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  14. Mobile Phone
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  15. Other Contact
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  16. Do you have lived experience of mental illness?
  17. (*)


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  18. (Fill in the Application for Associate Membership instead)
  19. COMMUNICATION PREFERENCES:
  20. Best way to contact me(*)





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  21. Do you want to receive Newsletters and other information?(*)



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  22. Please send information about AGM and other major events to:(*)



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  23. DEMOGRAPHICS:
  24. Year of birth(*)
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  25. Aboriginal(*)
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  26. Torres Strait Islander(*)
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  27. Language other than English(*)


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  28. Please specify
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  29. Gender(*)
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  30. INTEREST and INVOLVEMENT IN NETWORK ACTIVITIES:
  31. Self-Advocacy and Consumer Representation Training (SCR) - You can select more than one(*)





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  32. (Please specify which organisation you completed the course with)
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  34. Consumer Rep Program(*)


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  35. Policy and Projects Program(*)


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  36. Policy and Projects areas that I want to be involved in:
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  38. Network Events(*)


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  39. Thank you for taking the time to complete this information.