Membership *

Individual Member

Total Amount

Membership form

Your contact information

These questions are about who you are and how best to contact you.

First name *

Last name *

Email *

If you do not have an email address, you must provide your street address in the fields below. *

Street address

Suburb

State

Postal code

Country

Mobile phone

Please only select postal mail if you require post for accessibility.

Preferred communication method *

We may need to contact you from time to time via your preferred communication method in connection with your membership. We may also contact you to send our marketing communications if you opt-in (see Membership Declaration)

Would you like to be contacted about volunteering at PWDA?

Yes No

What topics listed would you be most interested in?

Access to justice

NDIS issues

Child safety

Housing

Accessibility

Transport

Community participation

LGBTQIA+

Social /current issues

Political issues

Income support

Employment

Violence prevention

International human rights

Culturally and Linguistically Diverse (CALD)

Disaster preparedness and recovery

Education

Psychosocial

Technology

Human rights protection

Healthcare

What areas listed below affect your daily life?

Access to justice

NDIS issues

Child safety

Housing

Accessibility

Transport

Community participation

LGBTQIA+

Social /current issues

Political issues

Income support

Employment

Violence prevention

International human rights

Culturally and Linguistically Diverse (CALD)

Disaster preparedness and recovery

Education

Psychosocial

Technology

Human rights protection

Healthcare

Would you consent to be contacted by PWDA about your experience in the topic areas selected to assist with PWDA's work?

Yes No

About you

The following section asks some questions about you, which will assist us in providing information to our members as well as assist our advocacy work. Most of these questions are completely optional. Please know this information will be kept confidential and in accordance with our privacy policy.

Age group

18-24

25-34

35-44

45-54

55-64

65+

Prefer not to say

Which one(s) best describes your gender or gender identity? *

Man

Woman

Non-binary

Gender non-conforming

Transgender

Cisgender

Intersex

Prefer not to say

Self description

Self description of gender or gender identity (if selected)

Which one (s) best describes your sexual Identity or sexual orientation?

Heterosexual

Gay

Lesbian

Bisexual

Pansexual

Queer

Asexual

Prefer not to say

Self description

Self description of sexual identity or sexual orientation (if selected)

Do you identify as being an Aboriginal and/or Torres Strait Islander?

Yes, I identify as Aboriginal

Yes, I identify as Torres Strait Islander

Yes, I identify as both Aboriginal and Torres Strait Islander

No, I do not

I prefer not to say

Do you identify as coming from a culturally and linguistically diverse background?

Yes No

If English is not your first language, what is your preferred language?

Please select your country of birth

Please select all that apply

Disability Type (Providing this information will assist us with our advocacy work)

Physical (for example, mobility issue, amputee, muscular dystrophy, spinal cord injury etc)

Neurological (for example, autism spectrum condition/disorder, ADHD Tourette’s etc)

Sensory (for example blind, deaf, deafblind etc)

Cognitive or intellectual disability (for example ABI, Down syndrome, etc)

Psychosocial (for example, permanent psychiatric disability or mental health condition)

Prefer not to say

Other

Are you an NDIS participant?

Yes No Prefer not to say

Please disclose anything you wish about your disability here (Optional)

Membership declaration

Membership Information

I have, or my support worker or guardian on my behalf has, read the membership prospectus and understand the conditions of membership.

In order to join PWDA, you need to be a person with disability, a resident of Australia, and 18 years old or over.

Eligibility

I confirm, or my support worker or guardian on my behalf confirms, that I am eligible to join PWDA.

I agree to PWDA's privacy policy

Membership register consent

I consent, or my support worker or guardian on my behalf consents, to my name and membership details being included as a member on PWDA’s membership register, in response to any requests made by other members of PWDA about the PWDA’s membership register.

Direct Marketing consent

I consent, or my carer or guardian on my behalf consents, to receiving direct marketing communications and information from PWDA about PWDA’s products and services, and updates about the PWDA’s advocacy, news and upcoming events via our newsletter that may be of interest to me via mail, SMS and/or email.

Enter your email address and check the box next to each mailing list you want to join. Then click the Subscribe button. You will receive a confirmation request via email for each selected list. Activate your subscription to each list by responding to the corresponding confirmation email.

Mailing List Subscription

Group(s)

PWDA Media

You will receive PWDA media releases and other media alerts as they are sent

PWDA Newsletter

You will receive the PWDA newsletter which is sent out once a month.

Weekly Media Round-up

You will receive an email each week with a list of the latest disability related news from Australia and the world.

name1

timestamp

empowered by

CiviCRM

Become a Member

Your contact information

About you

Membership declaration