PWSA VIC Membership Form 2018/2019

MEMBERSHIP APPLICATION/RENEWAL FORM 2018/2019
The Prader-Willi Syndrome Association of Victoria Inc. (PWSA VIC) was established in 1978 by parents of children affected by the syndrome and is totally run by volunteers. It has a long history of providing help and information. Our membership focuses on Victoria, Tasmania and South Australia although anyone all around Australia or around the world is welcome to join.

Our members include parents and carers, extended family members and friends, professionals and interested supporters.

For an annual membership fee of $50, membership of PWSA VIC also gives you automatic membership of the Prader-Willi Syndrome Association of Australia.

Members receive a quarterly newsletter with up to date information as well as email notifications of upcoming events and dates and the opportunity to participate in research trials.

PWSA VIC offers access to in-service training and visits to day care centres, kindergartens, schools, work places and adult centres in Melbourne as well as interstate and rural areas via video conferencing.

As a member you will be invited to PWSA VIC run social events including our Time Out Camp, Family Day, Christmas Party and General Meetings and Information/Education sessions and workshops for free or at discounted prices. You will also be kept up to date of other events such as the Asia Pacific and International PWS Conferences.

Joining the Association gives you the opportunity to make contact with other parents and exchange information and be part of the Aussie PWS Community.

For queries or assistance please contact PWSA VIC on

ph: 0451 797 284 or email: info@pws.asn.au.
Type of Membership: *

Parents/Primary Carers Extended Family/Friends Organisations Renewal of Membership

Parents/Primary Carers Membership

Enter both parents' names and contact details if applicable
Name: *

First Name Last Name
Name:

First Name Last Name
E-mail 1: *
E-mail 2:
Phone Number 1: *
Phone Number 2:

Address: *

Street Address
Street Address Line 2
City	State
Post Code	Country

Language/s (other than English) spoken at home:

Details of the Person with PWS
Name of the Person with PWS: *

First Name Last Name
Date of Birth: *

- Day - Month Year
Gender: *

Male Female
Name of Centre/School/Day Program/Workplace the person with PWS attends: *
Father's Occupation: *
Mother's Occupation: *
PWS Type: *

Deletion in Chromosome 15 Uniparental Disomy (UPD) Imprinting Defect Don't Know
Place of Residence: *

Family Home Community Residential Unit

Sharing Information
Where does information about PWS come from?

It comes from parents willing to share information about their children who have PWS.

When researchers want to do a project on PWS, our Association may be asked if our members would take part. The PWSA of Australia has a professional advisory board who would evaluate any research project before it goes ahead.

Also, parents sometimes ask if we can put them in touch with other parents who may be experiencing a similar problem to themselves, or who have a similar aged child with PWS. Who better than another parent who understands what's involved and would be happy to share the benefit of their experiences?

Our Association records and maintains private and personal information on its databases and information registers. We comply with all the State and Federal privacy laws relating to storage and use of your private information. We respect your privacy. Under no circumstances will we provide your information to other people or organisations without your permission.

Our Privacy Policy can be viewed at http://pws.asn.au/privacy.html
Do you agree to be contacted to participate in research projects? *

Yes No
Do you agree to be contacted if another family needs advice? *

Yes No
Use of photos
PWSA of Victoria constantly needs photos to promote our organisation.

We need photos for our Website, Official Facebook pages, Newsletters, Association documents eg. Brochures, Invitations, Flyers, Training Material, etc.

Under no circumstances will we give your photographs to other people or organisations without your permission.
Do you give permission for PWSA VIC to use photos of you and/or your child/ren for promotional use as outlined above? *

Yes No

Extended Family/Friends Membership
Name/s: *
Type in two names if applicable
E-mail: *

Address: *

Street Address
Street Address Line 2
City	State
Post Code	Country

Phone Number: *
Name of the Person with PWS you are supporting: *
Your relationship to the Person with PWS : *

Organisations Membership
Organisation Name: *
Contact Person: *
E-mail: *

Address: *

Street Address
Street Address Line 2
City	State
Post Code	Country

Phone Number: *
Name and Age of the Person with PWS you are supporting: *
Name and Age of the Person with PWS you are supporting:
Name and Age of the Person with PWS you are supporting:

Renewal of Membership

If you are an existing member there is no need to fill in the whole form again. Just fill in your name and email address but please also enter in the comments if you have changed any details such as email, phone number and/or address.
Your name: *

First Name Last Name
Name of the person with PWS you are supporting: *

First Name Last Name
Your email address: *
example@example.com
Comment:

Feedback:

Any feedback whether positive or negative is always welcome
Please leave your questions, suggestions or a comments here:
Payment:
Options: *

I wish to pay the Membership Fee - $50.00 My child is under 2 years old - FREE I will send a Cheque I live outside of Victoria and/or I don't wish to pay right now
Fee
Donation:
Total
Total:

AUD Description
Please send confirmation/receipt email to: *
example@example.com
Should be Empty:

MEMBERSHIP APPLICATION/RENEWAL FORM 2018/2019

Parents/Primary Carers Membership

Details of the Person with PWS

Sharing Information

Use of photos

Extended Family/Friends Membership

Organisations Membership

Renewal of Membership

Feedback:

Payment: