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2021 Membership
Membership is valid for the calendar year in which the membership form is completed.
Please note, in order for your membership to be processed, details must be completed in full.
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* Indicates required question
First name
*
Your answer
Last name
*
Your answer
Email address
*
Your answer
Phone number
*
Your answer
Postal address (please include suburb and postcode)
*
Your answer
State/Country
*
Choose
Western Australia
Queensland
New South Wales
Victoria
Tasmania
Australian Capital Territory
South Australia
Northern Territory
Outside Australia
Date of Birth
*
MM
/
DD
/
YYYY
How do you describe your gender identity?
*
We require this information for statistical reporting to our funders.
Female
Male
In another way
Prefer not to say
Do you identify as
*
We require this information for statistical reporting to our funders.
Aboriginal
Torres Strait Islander
Neither
Prefer not to say
Required
Do you identify as a person with a disability?
*
We require this information for statistical reporting to our funders.
Yes
No
Prefer not to say
Do you come from a CALD (culturally and linguistically diverse) background?
*
We require this information for statistical reporting to our funders.
Yes
No
Prefer not to say
Would you like to be added to our database of teachers?
*
Yes
No
To acknowledge that the information you have provided is accurate and that you accept the terms of STRUT Dance Membership, please type your full name below, as an e-signature alternative.
*
Your answer
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