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

    State

    Postal address (if different)

    State

    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

    Demographics


    Aboriginal YesNo
    Torres Strait Islander YesNo

    Do you speak a language other than English at home?
    Yes (please specify)
    No


    MaleFemaleTransgenderIntersex
    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.