ACT Council of Social Service Inc. (ACTCOSS)

Associate Membership Application
(for Individuals)

Use this form if you are an individual seeking membership with ACTCOSS. If you are a not-for-profit community organisation, for-profit corporation, government body or statutory agency, please use other application forms available at

1. Your Contact Details

YourName:
Postal Address Line 1:
Postal Address Line 2:
Suburb: / State: / Postcode:
Phone: / Mobile:
Email:

2. Privacy & Contact Preferences

Your preferred contact method: / ☐Email ☐Phone ☐Post
Do we have permission to publish your first initial and last name in our annual report? Yes / No

3. Areas of Interest

Please list your areas of interest:

4. Membership Fee

Please select your membership category but do notsend payment (see Application Processover the page).If you are experiencing financial hardship, please let us know and we will look into alternative arrangements.

Annual Income / Fees
☐Concession / $20
☐Less than $40,000 / $40
☐More than $40,000 / $95

ACT Council of Social Service Inc. | 1/6 Gritten St, Weston ACT 2611 | Ph: 02 6202 7200 | |

ACTCOSS is committed to reconciliation, acknowledges the traditional custodians of the land and pays respect to elders past and present.

5. Support of ACTCOSS’ Vision and Objects

I am seeking membership of ACTCOSS and support its vision and objects:
  • To live in a fair and equitable community that respects and values diversity, human rights and sustainability and promotes justice, equity, reconciliation and social inclusion
  • The elimination of discrimination on the grounds of political affiliation, race, social origin, religion, age, disability, sex, marital status or pregnancy, against individuals or groups in their access to employment, services or resources
  • The elimination of poverty and the promotion of well-being of disadvantaged and vulnerable individuals and groups
  • A united Australia which respects this land of ours, values Aboriginal and Torres Strait Islander heritage and provides justice and equity for all.

Your Name:
Signature: / Date:
Send your application & supporting documents to: EMAIL:
POST: ACTCOSS Membership, 1/6 Gritten St, Weston ACT 2611

Application Process

Approval:Membership of ACTCOSS is subject to approval by the ACTCOSS Committee, which reviews membership applications once per month. ACTCOSS will notify you if we require more information for your application. Upon approval, we will send you an invoice.

Providing Payment: Please do not provide any payment until you have been notified by ACTCOSS of your membership being approved.

Fees: Fees apply for the financial year you joined. If you are joining between January and June, we will invoice you pro-rata for the remainder of the current financial year.Please note that fees may rise by CPI every two years.

Privacy:As an ACTCOSS member,your details are collected by ACTCOSS. We will use this data to contact you regarding your membership and matters of community interest. We will only use your personal information that you give us for this purpose and will not disclose it without your consent.

ACT Council of Social Service Inc. | 1/6 Gritten St, Weston ACT 2611 | Ph: 02 6202 7200 | |

ACTCOSS is committed to reconciliation, acknowledges the traditional custodians of the land and pays respect to elders past and present.