Membership Application Form

APPLICATION FOR MEMBERSHIP OF ASSOCIATION

Doula Network Australia Incorporated (incorporated under the Associations Incorporation Act 2009)
I,
Name *

First Name Last Name
of

Address: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Occupation *
This should be "Doula" or "Student doula".
hereby apply to become a member of the aforenamed incorporated association. In the event of my admission as a member, I agree to be bound by the constitution of the association for the time being in force.

Click here to download constitution.
Signature of applicant *
Please type your name here.
Date *
dd/mm/yyyy

If you do not know a current member of the association to nominate you, please select any member from the committee to be your 'proposer': www.doulanetwork.org/our-committee (Christa Buckland, Ellen Croucher, Jennie Barnard, Danera Wilkinson, Jennifer McCartin, Julia MacLeod, Vicki Hobbs). Type their name in the box below and put doulanetwork@gmail.com as the email.
I,
Full name of proposer *
You can use any committee member as your proposer if you wish.
a member of the association, nominate the applicant for membership of the association.
Signature of proposer *
Please type the proposer's name here.
Date *
dd/mm/yyyy
Proposer's email *
We will email them to verify. :)

If you do not know a current member of the association to second your nomination, please select any member from the committee to be your 'seconder' (must be different from the proposer - Christa Buckland, Ellen Croucher, Jennie Barnard, Danera Wilkinson, Jennifer McCartin, Julia MacLeod, Vicki Hobbs). Type their name in the box below and put doulanetwork@gmail.com as the email.
I,
Full name of seconder *
You can use any committee member as your seconder if you wish.
a member of the association, second the nomination of the applicant for membership of the association.
Signature of seconder *
Please type the seconder's name here.
Date *
dd/mm/yyyy
Seconder's email *
We will email them to verify. :)

Almost there... :)

Please provide some additional information about yourself. Items marked with an asterisk(*) are required fields. Other fields are optional.
E-mail *
Phone Number: *
Mobile
Birth Date: *

Day Month Year
Trained/training with, year: *
Please tell us briefly about your background and experience.
Other qualifications:
Website:
Where did you hear about us?

A Friend or colleauge Google Facebook Blog post

Register of members

(Clause 7 of Constitution)
We are required to keep a 'register of members' which includes:

- the name of the member
- their postal or residential address
- the date the member joined

This record (by law) must be open for inspection, free of charge, by any member of the association. Members cannot use this information for anything other than the purposes stated in the constitution (sending a newsletter, notice of meetings/events or other material relating to the association). You can request that your address and joining date be concealed from the 'open' record (only your name will be shown).

All information collected in this membership form, other than your name, address and the date you joined, will be kept in a separate, sealed record.
Please select one *

(a) I would like information about me to remain on the 'open' record of the register of members. I understand that other members of the association may have access to the record from time to time. (b) I would like all information about me (except my name) concealed from the 'open' record of the register of members.
The annual membership fee is $20 and is due upon completion of this form. Please indicate which payment method you will be using. If for any reason your application is not successful, we will refund your payment immediately.
Payment method: *

Bank transfer: BSB: 033-174 (Westpac), Account Number: 446783, Account Name: Doula Network Australia Inc. PayPal: doulanetwork@gmail.com or https://www.paypal.me/doulanetwork
Thank you for your application! We will send you a welcome email shortly. Please add doulanetwork@gmail.com to your contact list so that our emails do not go into your junk/spam folder.

When you click submit (below), you will be automatically sent a copy for your records. If this does not occur then it means we have not received your application either. Please let us know if you have had difficulty completing this form. :)
Should be Empty:

APPLICATION FOR MEMBERSHIP OF ASSOCIATION

Register of members