Application for Individual or Associate Membership - (original survey)

Please complete this form to become an Individual or Associate Member

Please complete this form to become either an Individual or Associate member of Disability Sport & Recreation.

Membership is free

DSR ensures that all membership details are securely maintained and are not provided to any external parties (Privacy Policy)

If you have any questions, please ring (03) 9473 0133 or email karla@dsr.org.au

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* 1. Applicant's contact details

Title *

First name *

Surname *

Address *

Suburb *

State

Postcode

Contact number

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* 2. Email address

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* 3. Date of birth

Date

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* 4. Gender:

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* 5. Membership category

Individual member - A person who identifies as having disability

Associate member - A person who does not identify as having disability

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* 6. Type of disability (Individual members only)

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* 7. Do you identify as Aboriginal or Torres Strait Islander?

Yes

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* 8. Do you have specific communication needs?

Yes

If "yes", please provide more information

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* 9. Parent, advocate or emergency contact information

First name

Surname

Relationship

Contact number

Most parents and support workers also become an Associate member. Please indicate here if you do not wish for this to occur

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* 1. Applicant's contact details

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* 2. Email address

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* 3. Date of birth

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* 4. Gender:

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* 5. Membership category

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* 6. Type of disability (Individual members only)

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* 7. Do you identify as Aboriginal or Torres Strait Islander?

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* 8. Do you have specific communication needs?

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* 9. Parent, advocate or emergency contact information

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* 10. I am interested in volunteering with Disability Sport & Recreation