Pride Australia - Membership Form
Membership Type
Adult (18+)
Youth (12-17)
Legal Name
Preferred Name
Date of Birth
/
Day
/
Month
Year
Pronouns
Sexuality
Gender Identity
Mobile Number
Email Address
Address
Address
Street Address Line 2
Suburb
Postcode
State
Which groups / activities are you interested in?
Pride Social Group
Trans & Gender Diverse Social Group (16+)
Pride Youth Group (12-15)
Pride Youth Group (16-17)
Drag Social Group
WA Pride Social Group (Online)
QLD Pride Social Group (Online)
Name of Guardian (under 18 only)
Guardian's Mobile Number (under 18 only, for use in an emergency)
Submit
Should be Empty: