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Emerge Australia Membership

Please fill in the following details to renew your membership or become a member. We offer annual pricing options of $5 for people experiencing financial hardship, no evidence is required, or $50 full membership. You can select the option suitable for you at the bottom of this form.

Please note this is an application form for membership - if for any reason you are not eligible for membership we will inform you directly and provide a refund of your membership fee.

I am

applying for membership

renewing membership

Contact Information

Name

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Home phone (please provide area code)

Mobile phone

Email address

Verify Email

Date of birth

(dd/mm/yyyy)

Would you like to receive our annual Emerge Australia Journal via email or post?

Post

Would you like to receive a member pack in the post?

Each member pack includes a welcome letter, copy of the journal, various fliers for our services and an invisible disability lanyard.

Yes, please send me a complete member pack

No, please do not send the member pack

I would only like the invisible disability lanyard sent

I am a:

Person with ME/CFS

Carer of someone with ME/CFS

Family member of someone with ME/CFS

Friend of someone with ME/CFS

Other

Amount

$5 - Membership (Financial Hardship)

$50 - Membership

Additional optional donation