Gippsland Pride Initiative 2021 New Membership Form
This form is an application for Membership for the Gippsland Pride Initiative Inc.

Applications are reviewed monthly and do not constitute acceptance. Approved members will be notified immediately thereafter, with an invoice to be paid prior to membership confirmation. Membership will be contingent on compliance with the Gippsland Pride Initiative Policies and Procedures. Membership benefits will be communicated in coming weeks.

To be eligible for a Committee role, please complete the application for membership before emailing your nomination to admin@gippslandprideinitiative.com

These details are recorded securely and not utilised for any other purposes without your express permission prior. If any of these details change with time, please complete a new form and your previous record will be archived.

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Email *
Your Full Name (first name, surname): *
Your preferred name (how you’d like to be introduced to others) *
Are you a member of the LGBTQI+ Community or an Ally? Identifying as LGBTQI+ is in no way a condition of membership. *
Type of Membership *
Residential Address (Where you live):
Postal Address (Where your mail goes to): *
Date of Birth: *
Mobile phone number: *
Who is your next of Kin? (Emergency Contact):
Emergency contact phone number
Do you suffer from any allergies or food intolerance, and if so, please advise details;
Do you require any reasonable adjustment, assistance or access considerations to our meeting or event venues or activities? *
If you are wishing to be considered for a Committee role, are you ELIGIBLE for a satisfactory Working with Children Check and National Police Check? *
Thank You!
Where to from here?

Your details will be received and your application will be tabled at our next meeting.

You will be contacted upon a decision being made on your application, and invoice if your membership attracts a fee.
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