Join now ACD Membership Application Form Once your membership has been approved you will receive confirmation by post. Please don't hesitate to contact us in the meantime if you have any questions or concerns. Title*TitleName* First Last Organisation (if applicable)OrganisationAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*MobileFaxCan we contact you by email? Yes I would like to receive emails from ACD to the following email address: Email* Enter Email Confirm Email Can we contact you from time to time about focus groups, consultations and surveys? Yes No Type of membership*Please chooseFREE Family Membership for the first 12 monthsOrganisational MembershipInterested Person or Student MembershipFREE Family Membership for the first 12 months I would like to take out a family membership FREE for the first 12 months (then $16.50 (GST Inc) per year) I am*a parent/carera siblinga person with a disabilitya grandparentextended familyChild's with a disability's name* First Last Child's disabilityChild's date of birth* DD MM YYYY Sibling/s names and Date/s of birthSibling's first nameSibling's last nameSibling's date of birth Organisational Membership I would like to take out an organisational membership ($55 (GST Inc) per year I ama community organisationa professionalInterested Person or Student Membership I would like to take out a membership as an interested person for $16.50 (GST Inc) per year) I aman interested persona studentMake a donation with your membership I would like to make a donation. The generosity of our members and supporters is a key factor in the strength of our organisation. As a registered charity, all donations over $2 are tax deductible. After submitting this application form, we will display a secure "Give now" link to make your donation. Your generosity is highly valued. Terms and conditions of ACD membership* I support the purposes and rules of the Association for Children with a Disability (ACD) and accept the terms and conditions of application for membership as detailed on the ACD website acd.org.au Your date of birth* DD MM YYYY For voting rights you must be 18 years or over.How did you hear about us?InternetFamily or friendReferred by an organisationOtherIf 'other' please tell us moreEmail Security CheckEmailThis field is for validation purposes and should be left unchanged.