Please enable JavaScript in your browser to complete this form.Type of membership *QDN support organisation – a tax deductible fee of $35 per year applies* By this application you are applying to be a member of QDN and agree to be bound by its constitution. **QDN is covered for $20 000 000 in Public Liability insurance.Organisation name *Organisation ABN *My Username (Your organisations name with no spaces. You will use this Username when you log in to pay your annual subscription) *Contact person's title (Mr, Mrs, Miss) *Contact person's first name *Contact person's last name *Contact 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) *Best phone number *Address (street number and name or PO Box) *Suburb *Postcode *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 diverseOtherPrefer to receive information by: *EmailSocial mediaPostI 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.Annual feePrice: $35.00EmailSubmit
