Please enable JavaScript in your browser to complete this form.Type of membership *QDN supporter – free to join* By this application you are applying to be a supporter of QDN and agree to be bound by its constitution. **QDN is covered for $20 000 000 in Public Liability insurance.My title (Mr, Mrs, Miss) *My first name *My last name *My email address (If you do not currently have an email address you can get a free one at https://support.google.com/mail/answer/56256?hl=en – just copy and paste this link into your search engine) *My best phone number *My address (street number and name or PO Box) *Suburb *Postcode *I identify as: *AboriginalTorres Strait IslanderLGBTIQ+ (Lesbian, Gay, Bisexual, Transgender, Intersexual, Queer+)Coming from another cultural backgroundMy areas of interest: *NDISEducationRural and RemoteHealthMedical aids and equipmentAccessibilityAgeingWomenIncome support/pensionsHousing and accommodationAssistive technologyJustice and legal issues for people with disabilityAboriginal/Torres Strait IslanderResearchEmploymentTransportHuman RightsCost of livingCulturally and linguistically diverseOtherI'd like to receive information by: *EmailsSocial MediaBulk EmailsPhone CallsMailsI would like to be involved with QDN by connecting with peers: *Face to face meetingsOnline groups (regular online chats)I would like to have a voice in disability policy via: *Policy discussion forum group (online or face to face meetings)Focus groups discussions (one off meetings)Consent for collection, use and disclosure of personal information *By agreeing to become a member, I 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.PhoneSubmit
