Salutation--None--Mr. Ms. Mrs. Dr. Prof. Mx. First Name Last Name Phone Personal Email Address Suburb Postcode State: Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Year of Birth: Gender:--None--Female Male Non-Binary Prefer Not To Say Do you identify as Aboriginal or Torres Strait Islander?--None--Yes No What culture are you associated with?:--None--Afghanistan Albania Algeria Andorra Angola Anguilla Antigua and Barbuda Argentina Argentinian Antarctic Territory Armenia Aruba Australia Australian Antarctic Territory Australian External Territories, nec Austria Azerbaijan Bahamas Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Antarctic Territory Brunei Darussalam Bulgaria Burkina Faso Burma (Myanmar) Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile Chilean Antarctic Territory China China (excludes SARs and Taiwan Province) Columbia Comoros Congo Congo, Democratic Republic of Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Falkland Islands Fiji Finland Former Yugoslav Republic of Macedonia (FYROM) France French Guiana French Polynesia Gabon Gambia Gaza Strip and West Bank Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Holy See Honduras Hong Kong (SAR of China) Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of (North) Korea, Republic of (South) Kuwait Kyrgyz Republic Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau (SAR of China) Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Africa, nec Northern Ireland Northern Mariana Islands Norway Not stated/inadequately described Not Supplied or Insufficient Information Oman Other, Not Elsewhere Classified Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Phillipines Poland Polynesia (excludes Hawaii), nec Portugal Puerto Rico Qatar Queen Maud Land (Norway) Reunion Romania Ross Dependency (New Zealand) Russian Federation Rwanda Samoa Samoa, American San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South America, nec Southern and East Africa, nec Spain Sri Lanka St Helena St Kitts and Nevis St Lucia St Pierre and Miquelon St Vincent and the Grenadines Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, United States Wales Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe List the top three ways that you would like to be involved in BEING - Mental Health Consumers Limited (BEING)'s work\? (e.g. participating in consultations/workshops, training opportunities, sharing your story,volunteering etc.) Interest 1:--None--Consultation Workshops Training Sharing your story Committee Codesign Peer workforce Other Interest 2:--None--Consultation Workshops Training Sharing your story Committee Codesign Peer workforce Other Interest 3:--None--Consultation Workshops Training Sharing your story Committee Codesign Peer workforce Other I am 18 years old, or older: I am a resident of New South Wales: I have read BEING's Constitution and support the purpose of BEING's work (including the objects in clause 6.1): I have read BEING's Code of Conduct and agree to be bound by it: I consent to becoming a member of BEING if my application is successful: I give permission for BEING to contact me regarding my application and, if successful, my membership: I would like to subscribe to receive BEING's news and updates: As part of BEING's application process, we require two written references from any of the following: Most recent employer Community group or community centre leader Professional organisation (e.g. if you are an engineer, from a professional engineering body) Church / temple / mosque leader A person who is currently, or was recently, active in the Mental Health advocacy community. In providing the references, please note the requirements below: Your referees must have known you in either a personal or professional capacity for at least 12 months, and Your referees cannot be related to you, and The reference letter must speak about your good character Privacy and confidentiality agreement: Terms and Conditions: I understand and acknowledge that all applications for membership are reviewed by the BEING - Mental Health Consumers Limited board of directors on a regular basis. The Board will consider each application and approve or decline each application at its discretion. I understand that BEING - Mental Health Consumers Limited maintains a members register in accordance with its Constitution and the Corporations Act. I also agree to be boundby BEING-MentalHealthConsumers Limited's PrivacyPolicy,whichis available here. I accept the terms and conditions: Membership Type:BEING Member BEING Lived Experience Network Peer workforce network Mad Monday Memo Subscriber