formation.org.au Ltd. Individual Membership Form

formation.org.au Ltd. Individual Membership Form

If you require assistance completing this form, please contact us on 0410 933 324 or via email at hello@formation.org.au
linkedOrganisationId
individualId
1. Email*
2. Mobile*
Phone Number
3. Title

MissMs.Mrs.Mx.Mr.Dr.Sr.Rev.Mons.Very Rev.Most Rev.Prefer Not to SayOther
4. Name*

First NameLast Name
5. Date of Birth*

DayMonthYear
6. Physical Address*

Address Line 1

Address Line 2

SuburbState

PostcodeTraditional Country/Place (if known)
Postal address is same as physical address
Postal Address*

Address Line 1

Address Line 2

SuburbState

PostcodeTraditional Country/Place (if known)
7. Do you have accessibility requirements?*

YesNo
Please provide details*
8. Organisation*
9. Organisation URL*
10. Professional Position / Title*
11. Employment Type*

Full-timePart-timeCasualConsultantVolunteerOther
12. LinkedIn Profile URL
13. Years of service in current role*
14. Total years of service in Formation*
15. Headshot / Profile Image

Cancelof
16. Professional Qualifications and Achievements
17. Type of Membership*

Professional Membership (Annual Fee $220AUD)Young Professional Membership (Annual Fee $125AUD)Affiliate Membership (Annual Fee $60AUD)
18. What interests you most about formation.org.au? [Tick all that apply]
Connection and Community
Wisdom and Strategy Circle
Research and Discovery
Learning and Leading
19. How did you hear about us?*

LinkedInAt a ConferenceWord of MouthOther
20. Have you been a member of formation.org.au Ltd. before?
YesNo
When?*

DayMonthYear
21. Do you belong to any other professional membership associations?*

YesNo
Please provide details*
22. Are you currently, or have you ever been under suspension or disqualified from any professional membership or similar associations?*

YesNo
Please provide details*
I consent to act in accordance with the Membership Charter and Constitution of formation.org.au Ltd
I consent to receiving communications from formation.org.au Ltd and its affiliated partners
I consent to the storage and use of your personal information by formation.org.au in accordance with the Privacy Act 1988 (Commonwealth), and in a manner compliant with the Australian Charities and Not-for-Profit Commission
Acknowledgement and Declaration
I hereby declare that the information provided in this application is true and correct to the best of my knowledge. I understand that providing false or misleading information may result in the rejection of my application or termination of my membership.

I acknowledge that, if accepted as a member of formation.org.au Ltd., I agree to be bound by its Constitution, rules, and any code of conduct or policies in place, and to act in the best interests of the Association at all times.

I also consent to the collection, use, and storage of my personal information in accordance with the Privacy Act 1988 (Cth) and the Association’s Privacy Policy.
Signature

Clear
Please verify that you are human*
Membership Cost
Should be Empty:

formation.org.au Ltd. Individual Membership Form

Acknowledgement and Declaration