Membership with Spinal Life Australia « Spinal Life Australia

Becoming a Spinal Life member is free and by joining our community, you can make the most of:

Under our Constitution, members are invited to the Annual General Meeting each year to have a say in our future direction.

If you have any questions, please contact members@spinal.com.au or 1300 774 625 – we’d love to hear from you!

Apply to become a member

Renew your membership

Section A - Personal Information
Name*
First Last
Email*
Date of birth*
DD slash MM slash YYYY
Gender*
Phone (Mobile)*
Phone (Home)
Address*
Street Address City/Suburb State Postcode
Section C - Personal and health information
Tell us about your disability*
- Spinal cord injury
- Post-Polio Syndrome
- Transverse Myelitis
- Other (please specify)
Level of injury*
Please specify other disability*
Section E - Your privacy
The personal information you provide us on this Membership application form will be used to process your application and will allow us to deliver services, share relevant offers and other marketing promotions from time-to-time. Some of the information you provide, we are required to collect by law. Failure to provide the requested information may result in us not being able to process your application. At times, we may be requested to disclose your information to other service providers, government agencies, research companies or health professionals but we will only do so with your consent, and wherever possible information will be de-identified to protect your privacy. If you have any questions, please contact Spinal Life Australia by emailing privacy@spinal.com.au, and for further information please refer to our Privacy policy by clicking here.
Have you read and agreed with the Privacy Policy?*
- Yes - I have read, and give my consent
- No – I have read, but do not consent
CAPTCHA

Section A - Personal Information
Name*
First Last
Phone*
Email*
Membership ID
Have your contact details changed?*
- No
- Yes
If yes, please enter your new contact details below.
Section C - Donation
Would you like to make a donation to support Spinal Life Australia?*
- Yes
- No
Donation Amount*
How much would you like to donate?
Section D - Donation payment details
Thank you for your donation to Spinal Life Australia. Your gift will help support our mission to empower the lives of people with spinal cord damage through peer support, advocacy and more.
Total due
$ 0.00
Credit Card*

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Section E - Your privacy
Spinal Life Australia is collecting the information on this form for membership purposes. Only authorised employees of the organisation have access to this information. Your personal information will not be disclosed to any other third party without your consent, unless authorised or required by law. A full version of the Privacy Policy can be accessed by clicking here.
Have you read and agreed with the Privacy Policy?*
- Yes - I have read and agree
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

Membership with Spinal Life Australia