Application Form - Achilles Melbourne Incorporated

Membership Application Form

Please complete this form to apply for financial membership with Achilles Melbourne. All fields are mandatory except for Police Check, Working with Children Check and COVID 19 vaccination status.

Membership is $30 for standard membership and $20 for financial hardship (please contact melb.members@achillesaustralia.org.au before selecting this option).

Email Address

First Name

Last Name

Phone

Address Details

City

Postal Code

Country

Medical conditions or injuries

Do you have a disability?

Emergency contact Name

Emergency contact number

Current ability (Eg walking only)

Police Check Date

Police Check Document

Working with Children Card Number

Working with children expiry date

Birth Date

Membership Type

Membership Plans

I accept Achilles Melbourne terms of use, terms of use and privacy policy.

Achilles Melbourne Incorporated

e: melbourne@achillesaustralia.org.au | m: 0468 373 373 | w: http://www.achillesaustralia.org.au/melbourne

a: PO Box 12298, A'Beckett St, 8006

ABN 23 710 114 988 | CAV A0090621G