DNA Membership Application Form

APPLICATION FOR MEMBERSHIP OF ASSOCIATION

Doula Network Australia Incorporated (incorporated under the Associations Incorporation Act 2009)
PLEASE NOTE: If you have been a previous membership or have been a member with DNA in the past, please email: doulanetwork@gmail.com BEFORE filling in this form.
Name*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:*
Mobile
E-mail*
example@example.com
Birth Date:*

DayMonthYear
Occupation*
This should be "Doula" or "Student doula".
I hereby apply to become a member of the Doula Network Australia 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.
Signature of applicant*
Please type your name here.
Date*
dd/mm/yyyy
Model Constitution.
I acknowledge that I have read and accepted the terms of the DNA Model Constitution.*

Yes, I agree.

Proposer & Seconder
Full name of Proposer (DNA Committee Member)*
You can use any committee member as your proposer.
Please find the list of Commttiee Members here
If you know a current member of the association to second your nomination, please enter their name as the Seconder.
Full name of Seconder (Doula Network Member)*
You can use any Committee Member as your Seconder if you do not know a current Member.
Seconder's email (If your Seconder is a DNA Committee Member please enter doulanetwork@gmail.com as the email address *
We will email them to verify.

Training & Provider
Please provide some additional information about you and your training. Items marked with an asterisk(*) are required fields. Other fields are optional.
Name of Doula Course/Training *
Date*

DayMonthYear
Date completed - (Date enrolled if still a Student)
Other Training or relevant Qualifications.
Please tell us briefly about your background and experience.
Your Website:
Facebook:
Instagram:
Where did you hear about us?

A Friend or colleagueGoogleFacebook/InstagramBlog postOther

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.
What is your Facebook Account Name that you will use when joining the Doula Network Association PRIVATE Facebook Group? This will facilitate a smooth process when requesting to join DNA. *
Please type your details above
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 of $35.00 and is PAYABLE upon completion of this form. After clicking submit below you will be redirected to the payment portal. Your nominated Credit Card will be debited AUTOMATICALLY $35.00 annually from your joining date. If you have a COUPON your payment method will still need to be entered in order for your next annual membership fee.
Payment:*

I understand that I will be redirected to the payment portal when I click "submit" and will attend to payment immediately.I understand that I will be AUTOMATICALLY debited $35 annually (per year), until I choose to cancel my membership with Doula Network Australia.
Thank you for your application! When you click submit (below) you will be redirected to a payment page. Once you pay you will have instant access to our membership site and will receive a welcome email. You will also receive a copy of this form for your records.

Please check your spam folder in case the emails land there and allow access for Kajabi emails.

If you do not receive our emails, then it means something has gone wrong and we have not received your application. Please let us know if you have had difficulty completing this form.
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APPLICATION FOR MEMBERSHIP OF ASSOCIATION

Proposer & Seconder

Training & Provider

Register of members