QDN Member Application - Queenslanders With Disability Network

Type of membership

QDN Ordinary Member* (a person with a disability) – free to join and has voting rights**

* By this application you are applying to be a member of QDN and agree to be bound by its constitution.
** Ordinary members have the right to vote and be Elected Director of the QDN Board. QDN is covered for $20,000,000 in Public Liability insurance.

To become a new QDN member, you need another QDN member to nominate you or support your application.

If you know a QDN member, select "A QDN Member" from the options below, and enter their name in the box.

If you don’t know any QDN members, that’s okay. A QDN Director can support your nomination instead. In this case, select "I would like QDN to contact me for nomination".

I have been nominated for QDN Membership by: *

A QDN Member (please enter their name below)
I don't know a QDN member, but I want to apply for QDN Membership. (QDN will contact you and a QDN Director will act as your nominee.)

I know a QDN Member and they have agreed to nominate me. Their name is: *

My title (Mr, Mrs, Miss) and pronouns *

My first name *

My last name *

My email address *

(If you do not currently have an email address, you can create a free one through Google. Find out more here: https://support.google.com/mail/answer/56256?hl=en. You can copy and paste the link into your browser.)

My best phone number *

My address (street number and name or PO Box) *

Suburb *

State *

Postcode *

If you are not a Queensland resident, please tell us your connection to Queensland?

I identify as: *

If Other, please describe

My disability is: *

If "Other" Please describe your disability:

Are there any further details about your disability or accessibility support that you would like to share with us?

My areas of interest - Please tick the box/boxes that you are interested in:

If Other, please describe:

Consent for collection, use and disclosure of personal membership application form information. Please check the boxes below. *

I acknowledge the terms of the Privacy Policy which can be read at https://qdn.org.au/privacy/
I acknowledge the Members Code of Conduct that can be read at https://qdn.org.au/membership/member-policies/
I acknowledge that I am over 18 years of age

We collect and use personal and sensitive information solely for the purpose of delivering our programs, services, and advocacy activities, including communication. We do not disclose personal information to third parties except where required or authorised by law or with consent. We take reasonable steps to securely store personal information and to delete or deidentify it when no longer required for the purpose for which it was collected, in accordance with applicable privacy laws. By submitting this application to become a member, you authorise and consent to Queenslanders with Disability Network (QDN) to collect, use and disclose personal information for the purposes provided under this form, privacy notice and privacy policy. This form must be submitted by, or at the direction of the applicant. Once we have your application, we will be in contact to let you know the next steps. Thanks again for joining QDN