Association Membership Application

Association Membership Application and Renewal
If you are purchasing membership on behalf of another person please enter your name and email in the fields provided, thank you.
Purchaser''s Full Name*

First NameLast Name
Purchaser''s Email*
Member's Full Name*

First NameLast Name
Please use your personal email address and not a business or 'place of work' email address.
Member's E-mail*
Member's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Member's Phone Number*

Area CodePhone Number
Member's Interest*

Person with a disabilityFamily / Friend / Unpaid SupporterSupport Worker / Professional
Membership Status*

New MembershipRenewing Membership
View Terms & Conditions
Terms & Conditions*

I have read and agree to the Terms & Conditions of the Belonging Matters Association
Membership*

I understand that I am joining as an individual person, not as an organisation.
Membership Type - Please select one option only
prevnext( X )
New Association Member$20.00AUD
To join as a new member, or rejoin after an extended break. Please choose this option. The cost covers your one-off joining fee and annual fee all in one payment. *Please note that new memberships are subject to Board Approval.

Returning Member - Renewal Fee$10.00AUD
Are you a returning member wishing to renew your membership for this year? Please choose this option. The cost covers your annual renewal fee.

Subtotal $0.00AUDTax $0.00AUDTotal $0.00AUD
Pay with PayPal

Please click one of the PayPal options to complete payment and submit the form.
Should be Empty:

Association Membership Application and Renewal