Individual

Financial year

Annual Membership - $12.00

Applicant name:*

Postal address:*

Phone:*

Mobile:

Fax:

Email:*

What is the main language spoken at home?

What is your country of origin?

Areas of interest & expertise

Aged Care
Family & Young People
Media
Child Safety & Child Care
Health
New & Emerging Communities
Cultural Development
Housing
Refugees
Disability
Immigration
Regional/Rural Communities
Education & Training
Language Support
Settlement
Employment
Legal & Human rights
Women
Environment
Local Government
Aboriginaland Torres Strait Islander
Lesbian, Gay, Bisexual, Transgender and/or Intersex
Other

Nomination (your application must be nominated by a financial member of ECCQ. If you do not know a financial member who can nominate you, state so in the following field, and we will be in touch.)

Please provide the name and contact details of the financial member

Individual

Membership

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