Do you have lived experience of mental illness?
Yes (please complete the rest of this form)No (do not complete this form. Complete and submit an Application for Associate Membership instead)

Contact details (Your name and at least on contact address/email is required)
Your name
Title (required)
MrMrsMsMissOther (please specify)

Your address


Postal address (if different)


Communication preferences
What is the best way for us to contact you?
EmailPostHome phoneWork PhoneMobile PhoneSMS

Do you want to receive newsletters and other information?
Yes by emailYes by postNo thank you

How should we send information about AGM's and other major events?
Home addressPostal addressEmail


Aboriginal YesNo
Torres Strait Islander YesNo

Do you speak a language other than English at home?
Yes (please specify)

Other (please specify)

Interest and Involvement in Network Activities
Self-Advocacy and Consumer Representation Training (SCR)

Consumer Representative Program

Policy and Projects Program
I want to be involved in discussions and projects in these areas (please specify below):I'm not currently able to be involved

Network Events

Than you for taking the time to complete and submit this information.