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2023-05-09T14:05:32+10:00
New Organisation Membership Application
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Thailand
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Tonga
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Türkiye
US Minor Outlying Islands
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Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Postal Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Do you have any other Offices in QLD?
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Contact Details
Member Representative Name (preferably CEO or Executive Level)
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First
Last
Position
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Mobile Number
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Email
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Member Representative Proxy
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First
Last
Position
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Mobile Number
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Email
*
How did you find out about QAMH and why are you interested in joining us?
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About Your Organisation
Number of staff
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Number of clients
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Service Delivery Age
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Youth (0 - 12 years)
Young persons (12 - 26 years)
Adults (18 - 65 years)
Older persons (65+)
Main Source Funding
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NDIS
QLD Health
PHN
Other Federal Government
Other State Government
Local Council
Fee for Service
Community Donations
Philanthropic
Other
Other (please specify)
All Area(s) of Operation
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Brisbane Metro North
Brisbane Metro South
Gold Coast
Sunshine Coast
Townsvillle
Central Queensland
Central West Queensland
North West Queensland
South West Queensland
West Moreton
Cairns & Hinterland
Darling Downs
Mackay
Torres & Cape
Wide Bay
Other
Other (please specify)
Does this Organisation provide services in regional, remote or rural areas?
*
Yes
No
Programs & Services Provided
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Aboriginal and/or Torres Strait Islander Support
Accommodation Support
Alcohol & Other Drugs
Carer Support &/or Respite
Clinical Services - Nursing & Allied Health
Coaching (eg CBT based programs)
Corrections & Transition
Counselling - Group/Individual
Creative Arts
Culturally and Linguistically Diverse (CALD)
Digital Mental Health Services
Domestic Violence
Employment/ Work Readiness
Financial Support
Homelessness
Housing Support & Tenancy
Independent Advocacy
Legal Service
LGBTIQA+
MH Awareness
Mental Health Recovery Support (Outreach)
NDIS
Parenting & Family
Perinatal
Refugee Support
Relationship
Residential Rehab - Step Up Step Down/CCU
Service Coordination
Social Enterprise
Suicide Prevention
Other
Condition Specific (please specify)
Other (please specify)
Membership Fees
Membership fee is based on previous financial year's annual mental health revenue for delivery of services within Queensland. This includes federal and psychosocial NDIS funding of these services.
Previous financial year's mental health revenue
*
Membership Fees (renewable annually on 1 July - GST exclusive)
*
Organisations with low income (under $100K) ($100 Membership Fee)
Organisations with an annual income up to $500K ($200 Membership Fee)
Organisations with an annual income up to $1M ($350 Membership Fee)
Organisations with an annual income between $1M and $3M ($800 Membership Fee)
Organisations with an annual income between $3M and $6M ($1,400 Membership Fee)
Organisations with an annual income between $6M and $10M ($2,800 Membership Fee)
Organisations with an annual income over $10M ($4,200 Membership Fee)
An invoice will be issued following confirmation of Board approval
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