General Membership

General Membership4sure2023-05-09T14:05:32+10:00

New Organisation Membership Application

"*" indicates required fields

Organisation Details

Organisation Type*

Government

Private Company

Incorporated Association

Not-for-Profit Organisation

Non-Governmental Organisation

Cooperative (Incorporated)

Public Company

Company Limited by Guarantee

Community Group

Organisation Name*

Trading Name (if applicable)

ABN/ ACN*

Office Phone Number*

Website*

Head Office Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Postal Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you have any other Offices in QLD?*

Contact Details

Member Representative Name (preferably CEO or Executive Level)*

First Last

Position*

Mobile Number*

Email*

Member Representative Proxy*

First Last

Position*

Mobile Number*

Email*

How did you find out about QAMH and why are you interested in joining us?*

About Your Organisation

Number of staff*

Number of clients*

Service Delivery Age*

Youth (0 - 12 years)

Young persons (12 - 26 years)

Adults (18 - 65 years)

Older persons (65+)

Main Source Funding*

Other (please specify)

All Area(s) of Operation*

Other (please specify)

Does this Organisation provide services in regional, remote or rural areas?*

Programs & Services Provided*

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

Declaration*

I have read, understand and agree with the Alliance Rules

Name

This field is for validation purposes and should be left unchanged.

28855

QAMH acknowledges the Traditional Custodians of the land on which we live, learn and work and recognise their continuing connection to land, waters and community. We pay our respect to them and their cultures; and to Elders both past, present and emerging.

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New Organisation Membership Application

Organisation Details

Contact Details

About Your Organisation

Membership Fees

An invoice will be issued following confirmation of Board approval

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