Associate Organisation Membership CONTACT DETAILS Your name and at least one contact address/email is required.Organisation/group name Type of organisation/group (if applicable) Contact Person Mr Mrs Ms Miss Mx Other Other Name First Last Preferred Pronouns He/Him She/Her They/Them Other Other Address Street Address Address Line 2 City State Post Code Postal Address (if different) Street Address Address Line 2 City State Post Code Email Office PhoneMobile PhoneOther contact name and number Website INCLUSIONS/ENTITLEMENTS Quarterly newsletters Your logo, info and link on our website Promotion of your events Use of meeting space Partnership and collaboration Election to the Network’s BoardCOMMUNICATION PREFERENCESWhat is the BEST way for us contact you Email Post Mobile Phone/SMS Home Phone Do you want to receive newsletters and other information? Yes by email Yes by post How should we send information about General Meetings? Email Postal address Home address Please note we are required by law to provide all members with notice and other documentation about General Meetings.ANNUAL CONTRIBUTIONS In order to support the Network’s core programs and enable beneficial relationships with like-minded organisations and groups there is a small annual contribution per organisation/group or individual. Organisations/groups and individuals who feel they are unable to pay their contribution may be eligible may request a contribution waiver or reduction.Contribution Rate based on annual funding < $100,000 ($60.00) > $100,000 ($120.00) Payment methodEFTChequeBSB: 062-919 Account number: 10168614 Account name: ACT Mental Health Consumer NetworkCheque made out to ACT Mental Health Consumer Network 68780
