PWSA VIC Membership Form 2019/2020

MEMBERSHIP APPLICATION/RENEWAL FORM 2019/2020
The Prader-Willi Syndrome Association of Victoria Inc. (PWSA VIC) was initially founded by parents of those living with Prader-Willi Syndrome (PWS) who wanted to better the lives of their loved ones. Over 40 years later, their legacy lives on and today the PWSA Vic offers its members much needed practical supports and services.

PWSA Vic offers 5 types of Membership:
- Friends of the Association - Person with PWS who wish to join as an individual and personally receive up to date information on events and news.
- PWS Family - Parents/Carers, Child with PWS and their Siblings.
- Extended Family and Friends - Relatives such as Grandparents, Aunt Uncles, Siblings with children of their own and any friends who wish to show their support to the family by becoming a member of the PWSA Vic.
- Professionals and Professional Organisations - who wish to support the PWSA Vic and be kept up to date regarding workshops, training opportunities, events and news.
- Supporters of PWS and PWSA Vic - Anyone wishing to lend their voice and show their support of PWS and the PWSA Vic Community.
Benefits of becoming a member:

As a member of the PWSA Vic, and depending on your membership type and your location, you may be eligible to gain access to the following supports and services:
- Free access to in-service training and visits to kindergartens, schools, workplaces and adult centres;
- Access to lectures and workshops presented by PWS experts;
- Access to advocacy when dealing with service providers or in a crisis situation;
- Access to PWS help line and support;
- Opportunities to meet other parents, families and carers;
- Access to current information about PWS and best practice;
- Access to free and discounted family friendly events such as the PWSA Vic Time Out Camp, Family Day and Christmas Party.
Your membership also means that you are helping PWSA Vic to provide supports and essential services to other families just like yours all while making a contribution to advocacy and awareness of Prader-Willi Syndrome.

The best part is that by joining the Association, this gives you the opportunity to make contact with other familes and friends of the Association and exchange information.

Annual membership of PWSA VIC also gives you automatic membership of the Prader-Willi Syndrome Association of Australia.

For queries or assistance please contact PWSA VIC on

ph: 0447778301 or email: info@pws.asn.au.
Type of Membership: *

Friends of the Association PWS Family Extended Family and/or Friends Professionals and Professional Organisations Supporters of PWS and PWSA Vic

PWS Family Membership

Parents/Carers, Child with PWS and their Siblings.
Have you previously been a member of PWSA Vic? *

Yes No Unsure
Name: *

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

Address 1: *

Street Address
Street Address Line 2
City	State
Post Code	Country

Name:

First Name Last Name
E-mail:
Phone Number:

Address 2 (if applicable):

Street Address
Street Address Line 2
City	State
Post Code	Country

Language/s (other than English) spoken at home:
Would you like to volunteer your time for the PWSA Vic *

Yes No Maybe - Please contact me to discuss

Details of siblings under 18.

*Adult siblings over 18 should register with Extended family membership. This information helps up better plan and organise our events.
Sibling 1

First Name Last Name
Gender:

Male Female
Date of birth

Day Month Year
Date Date Picker Icon
Sibling 2

First Name Last Name
Gender:

Male Female
Date of birth

Day Month Year
Date Date Picker Icon
Sibling 3

First Name Last Name
Gender:

Male Female
Date of birth

Day Month Year
Date Date Picker Icon
Sibling 4

First Name Last Name
Gender:

Male Female
Date of birth

Day Month Year
Date Date Picker Icon
Please advise PWSA Vic if more fields are required.

Professionals and Professional Organisation Membership
Have you previously been a member of PWSA Vic? *

Yes No Unsure
Are you Registering as an Organisation or an Individual? *

Organisation Individual
Organisation Name:
Name *

First Name Last Name
Professional Title: *
E-mail: *

Address: *

Street Address
Street Address Line 2
City	State
Post Code	Country

Organisation Phone Number: *
Organisation Website: *
Organisation Facebook Page:
Direct Phone Number
Name of the Person with PWS you are supporting (if applicable):
Full Name
Would you like to volunteer your time for the PWSA Vic *

Yes No Maybe - Please contact me to discuss

Supporters of PWS & PWSA Vic Membership

Anyone wishing to lend their voice and show their support of PWS and the PWSA Vic Community
Have you previously been a member of PWSA Vic? *

Yes No Unsure
Name: *

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

Address: *

Street Address
Street Address Line 2
City	State
Post Code	Country

Would you like to volunteer your time for the PWSA Vic *

Yes No Maybe - Please contact me to discuss

Sharing Information
If you are a Parent/Primary Carer:
Where does information about PWS come from?

A lot of the information that we have access to today about PWS, is in part due to parents and families that have been willing to share information about their loved ones, their own personal circumstances and their journey. This information sharing helps broaden our knowledge as a community and helps support the work that PWSA Vic do.

PWS Vic provides many supports and services, and prides themself on providing many opportunitues throughout the year for our families to come together and share information and stories. Occassionally, PWSA Vic will receive a call from a family wanting to reach out to someone who understands their journey and emotional state. Often, PWSA Vic will assist these families by linking them with other families in their area or families with similar aged children. If you have expressed interest in providing your support to the Association in this way, we will always contact you first before sharing your personal details to anyone.

When professional organisations such as Medical and research professionals are seeking participants for a clinical trial or for a project related to PWS, PWSA Vic members may be invited to take part via invitation extended to PWSA Vic. Please note that PWSA Vic will always contact our members with information regarding information sharing in these circumstances and under no circumstances will your details be provided without your consent.

PWSA Vic 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 with the option to participate in research projects? *

Yes No
Do you agree to be contacted by PWSA Vic if another family is seeking some peer support? *

Yes No

Digital Media Disclaimer

Please ensure you read and understand this disclaimer
Definition: Digital Media - Digital media are any media that are encoded in machine-readable formats. Digital media can be created, viewed, distributed, modified and preserved on digital electronics devices including but not limited to Photographs and Videography.

Disclaimer: The Prader-Willi Syndrome Association of Victoria (PWSA Vic) reserves the right to use any Digital Media taken at any event hosted by PWSA Vic, without the expressed written permission of those included within the photograph/video. PWSA Vic may use the Digital Media in publications or other media material produced, used or contracted by PWSA Vic including but not limited to: brochures, invitations, booklets, newspaper articles, social media publications, email notifications, websites, etc.

To ensure the privacy of individuals and children, Digital Media will not be identified using full names or personal identifying information without written approval from the subject, parent or legal guardian.

However, a person attending a PWSA Vic event who does not wish to have their image recorded for distribution should make their wishes known to the event organiser or alternatively the President of the PWSA Vic (president@pws.asn.au), in writing of his/her request and include a photograph. PWSA Vic will use the photo for identification purposes and will hold it in confidence.

By participating in a PWSA Vic event or by failing to notify PWSA Vic, in writing, your desire to not have your image used by PWSA Vic, you are agreeing to release, defend, hold harmless and indemnify PWSA Vic from any and all claims involving the use of your picture or likeness.

Any person or organisation, whether affiliated or not, with PWSA Vic may not use, copy, alter or modify PWSA Vic Digital Media without the advance written permission of an authorised designee from PWSA Vic.

Thank you for your understanding and co-operation!
I have read and understood the PWSA Vic Digital Media Disclaimer *

Yes I understand that I will need to contact President of the PWSA Vic in writing via email I do not agree with this disclaimer

MEMBERSHIP APPLICATION/RENEWAL FORM 2019/2020

Friends of the Association Membership

PWS Family Membership

Details of the Person with PWS only

Details of siblings under 18.

Extended Family and/or Friends Membership

Children

Professionals and Professional Organisation Membership

Supporters of PWS & PWSA Vic Membership

Sharing Information

Digital Media Disclaimer

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