Visability Membership Application Form

VisAbility Membership Application Form

Please refer to VisAbility’s Constitution for further information.

VISABILITY LTD – ACN 604 293 209 / ABN 11 157 291 960

Applicant Details

FULL NAME
(including title and any post-nominals)
ADDRESS
POSTAL ADDRESS
(if different to Address)
PREFERRED CORRESPONDENCE FORMAT
(email, standard print, large print, audio, Braille)

Payment Details

MEMBERSHIP FEE incl GST / $40.00
DONATION (over $2 is tax deductible) / $
TOTAL PAYABLE / $

Payment may be made by:

Cheque or money order to "VisAbility Limited" (please write your name on the back)

Electronic funds transfer to:

Account: 036-000 122221

Reference (essential): payee name

Credit Card (Visa / MasterCard / Amex / Diners)

Card Number: ______

Name on Card ______(please print)

Card Expiry Date ______/______

Signature: ______

For telephone credit card payment or enquiries call (08) 9311 8202.

Please tick if a receipt is required.

Return completed form in enclosed envelope to:

Member Liaison Officer, VisAbility Limited

PO Box 101, Victoria Park, WA, 6979

Applicant Declaration

Applicant to declare that (s)he understands and will uphold the Member Responsibilities.

Member undertaking

(refer Constitution clause 6.2)

Member applicants undertake to:

be bound by VisAbility’s Constitution and Policies;
pay the fees and subscription determined to apply to the Member under clause 9 (if any); and
support the Company in the encouragement and promotion of its Objects.

Member responsibilities

(refer Constitution clause 6.4)

Each Member will:

do all things necessary to enable the Objects to be achieved;
effectively promulgate and enforce the Constitution and Policies of the Company;
at all times act for and on behalf of the interest of the Company and Members;
be bound by the Constitution and the Policies;
act in good faith and loyalty to maintain and enhance the Company, its standards, quality and reputation for collective and mutual benefit of the Members; and
at all times operate with and promote mutual trust and confidence between the Company and the Members, promoting the economic success, strength and stability of each other and work co-operatively with each other in the pursuit of the Objectives.

Membership application and approval

(refer Constitution clause 6.5)

An applicant will become a Member upon submission of completed and approved application form and payment of fee. The Board may decline an application for membership at its absolute discretion. No right of appeal shall arise because of a decision of the Board to decline an application for membership. Unsuccessful Member applicants will be informed in writing

Cessation of membership

(refer Constitution clause 7.1)

A person ceases to be a Member on:

resignation, by giving 14 days’ written notice to the Directors;
death;
the termination of their membership according to this Constitution or the Policies;
and without limiting the foregoing:
that Member no longer meeting the requirements for membership according to clause 6; and
that Member ceasing to be a Member in accordance with clause 8.

Membership fees and subscription

(refer Constitution clause 2)

Directors determine whether there will be a Membership Fee and, if so, the amount of the annual subscription, the payment method and the date due.

VisAbility Membership Fees are set for a financial year; no pro-rata payment provisions apply.

Members may pay by cheque, money order, credit card or by cash if paying in person at the Perron Centre.

Membership disqualification or renewal refusal

If a Member has, to the knowledge of the organisation:

failed to comply with their responsibilities under clause 6.4 of VisAbility’s Constitution;
behaved in a manner which does not support or enable the objects of VisAbility to be achieved;
not acted for and on behalf of the interests of VisAbility and its Members;
not promulgated, enforced or acted in accordance with VisAbility’s Constitution or Policies;
not acted in good faith and loyalty to maintain and enhance VisAbility; its standards, quality and reputation for collective and mutual benefit of Members;
not continuously operated and promoted mutual trust and confidence between VisAbility and its Members, promoting their economic success, strength and stability;
behaved in a manner causing VisAbility staff, clients or other stakeholder to feel threatened, intimidated or at risk;
the Board may disqualify the person’s membership or refuse to person’s membership renewal. Should this occur, the person would be informed in writing.

Membership entitlements

Each Member:

may exercise one (1) vote (refer Constitution clause 12.1 b)
will receive notices of Annual and other General Meetings (refer Constitution clause 10.3)
may attend Annual and other General Meetings
may appoint a proxy to attend Annual and other General Meetings in his/her place (refer Constitution clause 10.11)
may appoint an attorney to act on his/her behalf at all or any of VisAbility’s Membership meetings (refer Constitution clause 10.13)
may nominate a Member for an elected Director Position
will receive a copy of VisAbility’s annual profit and loss account, balance sheet and auditors report (refer Constitution clause 19.1)
may inspect, free of charge, VisAbility’s minute books of a company at its registered office address or principal place of business; and receive a copy (for which there may be a charge).
will receive a copy of the Constitution on written request
may receive invitations to special VisAbility Member events
will receive corporate information via a regular, member-exclusive newsletter in nominated preferred format
will receive regular service related information via electronic newsletter
will receive up to 15% discount on selected products in the VisAbility Shop
will receive 15% discount on Aids for Daily Living products
may enjoy networking opportunities
may enjoy of any partner discounts offered.

Declaration

I have read and will uphold the member responsibilities. / SIGNED:
DATED:

VisAbility – Membership Application Form1