Individual Membership Application

Membership Details

Membership Details *

Individual - $ 66.00

Concession - $ 33.00

Please renew my membership automatically.

Total Amount

Please enter a Username to create an account. If you already have an account please login before completing this form.

Username *

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Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

Personal Details

Title

First Name *

Last Name *

Address Line 1 *

Address Line 2

Suburb *

Post Code *

State *

Gender

Female Male Non-binary Prefer not to say

Email *

Phone

Date of Birth

Category *

ADA 2014 hand Dance