Associate Membership Signup

If you want to complete the membership application form offline, download the form here.

MEMBERSHIP TYPES AND CRITERIA

Primary Membership

Associate

May have lived experience of mental illness but does not live and/or accesses services in the ACT
Is a carer or support person of someone with mental illness
Supports the aims of the Network

(Associate memberships are to be renewed annually)

Membership *

Associate

Total Amount

Email Address *

Individual Information

Title

Title (other)

First Name *

Last Name *

Street Address

Suburb

State *

Post Code

Country

Preferred Communication Method

Phone
Email
Postal Mail
SMS

Do you want to receive Newsletters and other information?

How should we send information about AGMs and other major events? *

Associate Membership Additional Information

Cultural Background

Main language(s) spoken at home

Main language spoken at home (other)

Year of Birth

Preferred Pronouns

Preferred Pronouns (Others)

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