Application to become an individual member of Disability Sport & Recreation

Your contact details

Please fill out this form to become an individual member of Disability Sport & Recreation (DSR).

Individual membership is for people with disability. If you don't have a disability, you can become an associate member instead. Membership is free.

We make sure that all membership details are kept safe. We will not give your details to anyone outside of DSR without your permission. Read our Privacy Policy: https://dsr.org.au/privacy-policy/

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

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* 1. Your first name

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* 2. Your last name

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* 3. Your gender

Male

Female

Transgender/non binary

Prefer not to say

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* 4. Your date of birth

Date

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* 5. Your disability (you can choose more than one)

Physical disability

Intellectual disability

Sensory disability

Psychological disability (mental health condition)

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* 6. Your email (this is how we'll contact you)

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* 7. Your phone number

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* 8. What suburb do you live in?

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* 9. What state or territory do you live in?

VIC

NSW

QLD

TAS

ACT