S.A.S.S.G Inc. New Membership Application
Sunraysia Autism Spectrum Support Group Inc. A0043222T ABN 28 255 657 022
2018 Application for New Membership
Membership Details:
As SASSG is a registered incorporation, it is very important that any one wanting to be a member has to submit an application to become one. The up to date details of current and new members will assist SASSG and members in many ways, and the most important one is having a members' correct details, as this will also assist SASSG when applying for funding.

All membership details are strictly for the use of SASSG, and your personal details will not be shared with any other organisation, without the written or verbal consent from the individual member/s. The only information that will be shared is the overall summarised information that is collated, for example; number of members, age groups etc... Membership is only available for parents and carers, who care for someone on the autism spectrum. You can also join as a member if you are 16+ and you are on the autism spectrum, and live independently or interdependently.

Parent - Biological, Foster, Legal guardian.
Carer - Any adult who frequently or routinely assist in the care of someone who is on the autism spectrum.

Please note that only one application per household is required.

First and last name *
(A) PRIMARY APPLICANT
Your answer
Date of Birth *
for identification purposes only (year can be changed. For iPhone or Smart phone, TAP on year first)
MM
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Your Occupation
Optional
Your answer
Partners first and last name
(B) SECONDARY APPLICANT - Optional (suggested if they are likely to attend events)
Your answer
Partner's Date of Birth
for identification purposes only (year can be changed - For iPhone or Smart phone, TAP on year first)
MM
/
DD
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YYYY
Partners Occupation
optional
Your answer
Residential address *
Your answer
Postal address (if different from residential)
Your answer
Your Phone number *
Your answer
Partners phone number
Optional
Your answer
Your email address *
Your answer
Partner's email address
Your answer
Do you care for children ages 1 to 17 years, on the autism spectrum *
Children that are or maybe on the autism spectrum
How many children ages 1 to 17 years on the autism spectrum do you care for. *
in your current household
How many other children ages 1 to 17 years live with you *
Not on the autism spectrum.
Do you care for adults 18+ years, on the autism spectrum *
Adults that are or maybe on the autism spectrum
How many adults 18+ years on the autism spectrum do you care for. *
in your current household
How many other adults 18+ years live with you *
Not on the autism spectrum. Including your partner, if not added above as a Secondary Applicant (B)
Does the person you care for have a case manager or support worker *
Children 1 to 17 years on the spectrum.
Does the person you care for have a case manager or support worker *
Adult 18+ on the spectrum.
Do you currently hold one of the following cards, must be valid. *
Information may assist SASSG with applying for funding. Your name will never be used, without your consent.
Do you or any of your family identify as *
Information may assist SASSG with applying for funding. You can choose multiple answers.
Required
Do you travel outside of Mildura for medical appointments, for the person you care for on the spectrum. *
Information will assist SASSG, when requesting funding.
As part of your membership, you agree to receive emails from SASSG Inc' *
SASSG only sends out emails occasionally, mainly around up coming events. You can choose Yes or No for partner.
Required
Are you a member on our Face Book page, 'Sunraysia Autism' SASSG Inc Discussion Page. *
Are you aware of the SASSG website, and do you access it *
sassg.org.au - you can choose more than one answer.
Required
How did you hear about SASSG *
Confirmation and Acceptance of Terms *
I the primary applicant (name stated above at (A)), solemnly declare that the information I have provided, is accurate as at the date of making this application to become a member of Sunraysia Autism Spectrum Support Group Inc. I am also able to substantiate, if requested by SASSG Inc. that I am and/or I do care for a child and/or adult who is on the Autism Spectrum Disorder, or awaiting a diagnosis. RESPECT and CONDUCT: If approved, I as a member will show respect at all times to other members and their families, when attending SASSG meeting/s and/or event/s, and promise to conduct myself/ourselves at all times, as not to bring SASSG Inc. in to disrepute.
Today's Date. *
For Acceptance of Terms
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