VFSN Membership Application Form

Membership Application
Vietnamese Families with Special Needs Inc.

Hội Khuyết Tật Việt Úc

Registered Incorporation No. A0045767J

ABN 94 107 747 656

The Vietnamese Families with Special Needs (VFSN) is a parent led, volunteer based Incorporated Association providing peer support, parent information and community inclusion opportunities to the Vietnamese Community living with disability. Currently most activities are based in the Western Region of Melbourne.

At the core of all its activities and services is the VFSN vision of living in a society where Vietnamese families who have a child with a disability live with respect and dignity, are able to reach their optimum wellbeing and capacity; and are understood and accepted without judgement and stigma.

Membership and fees

Membership is open to Vietnamese families who have a member with a disability. If you are unsure about eligbility, please contact us to discuss.

Become a member by completing the Membership Application Form and payment of an annual fee.

The Current Annual Memberhsip Fee is $20.00 AUD.

Privacy

Vietnamese Families with Special Needs only collects your information for the purpose of providing you with membership services. This includes using your email and address to send you newsletters, updates and event invitations.

Applicant information

Applicant name*

First NameLast Name

Date of birth

Date

Home phone

Mobile phone*

Address*

City / Suburb*

Postcode*

Applicant email

example@example.com

Able to speak English?*

YesNo

Emergency contact

Name *

First NameLast Name

Phone*

Address

City / Suburb

Postcode

Participants

Please provide details of all family members - for children and family members with a disability, please include DOB and the primary disability type where relevant. *

	Surname	Given name	Date of birth (for children and family members with a disability)	Disability
1
2
3
4
5
6

Payment options

1. Submit this Online Application Form + Paypal payment (choose below 2022 Membership Fee) ; or2. Print Application Form + Pay cash directly to a Committee Member (Go straight to signature and date and submit form)

Paying your Membership online is easy - you will be taken to the Paypal site once the form has been submitted. You will also receive a copy of the form by return email.

2022 Membership Fee($20.00AUD one-time payment)

Vietnamese Families with Special Needs - Annual Membership Fee

Total $0.00AUD

Signatures

Signature of applicant*

Date*

Date

Got a question?

Contact VFSN via email vn.specialneeds@gmail.com or call 0448417513.