MHCA Member Application Form
I am applying for: (*)



Invalid Input
Name of Organisation (*)

Invalid Input
Postal Address (*)

Invalid Input
Street Address (*)

Invalid Input
Phone Number (*)

Invalid Input
Fax Number (*)

Invalid Input
Email Address (*)

Invalid Input
Website

Invalid Input
State of Incorporation (if relevant)

Invalid Input
Application Nominator - Name and Organisation (Full member applicatiions ONLY)

Invalid Input Application nominator must be a current MHCA Member. A list of current members can be found at http://mhca.org.au/about-us/mhca-membership


Eligibility Criteria

Under the MHCA Constitution, to be eligible for full membership, and application organisation must fulfil one of the following criteria:

If appying for Full Membership, which description best describes your organisation?



Invalid Input
Membership Category (only complete if applying for full membership)

Invalid Input
Number of Members

Invalid Input
Member distribution



Invalid Input

Please complete the following questions if applying for Associate Membership:

Our organisation agrees to support the state objectives of the MHCA

Invalid Input
Number of Members

Invalid Input
Member distribution



Invalid Input


Nominated Delegate (applies to Full Member applications ONLY)

The nominated delegate is the person who represents your organisation to the MHCA. The delegate holds the voting rights at the MHCA Annual General Meetings. The nominated delegate should have the capacity, time, commitment and resources to fulfil their responsibilities and have the support of the organisations members.

Delegate Name

Invalid Input
Delegate Position in Organisation

Invalid Input
Delegate Email

Invalid Input
Delegate Phone Number

Invalid Input
Delegate Fax Number

Invalid Input
Delegate Mobile Number

Invalid Input
Delegate Postal Address

Invalid Input
Delegate Street Address

Invalid Input


Contact Person

The contact person may be the same person, or a different person to the nominated delegate. The contact person will receive general information from the MHCA and is expected to pass on information to the relevant people within the organisation.

Contact Name

Invalid Input
Contact Position in Organisation

Invalid Input
Contact Email

Invalid Input
Contact Phone Number

Invalid Input
Contact Fax Number

Invalid Input
Contact Mobile Number

Invalid Input
Contact Postal Address

Invalid Input
Contact Street Address

Invalid Input


CEO / Director



CEO / Director

Invalid Input
CEO Position in Organisation

Invalid Input
CEO Email

Invalid Input
CEO Phone Number

Invalid Input
CEO Fax Number

Invalid Input
CEO Mobile Number

Invalid Input
CEO Postal Address

Invalid Input
CEO Street Address

Invalid Input


President / Chair



President Name

Invalid Input
President Position in Organisation

Invalid Input
President Email

Invalid Input
President Phone Number

Invalid Input
President Fax Number

Invalid Input
President Mobile Number

Invalid Input
President Postal Address

Invalid Input
President Street Address

Invalid Input


Communication with MHCA Members

The MHCA uses a listserv (an email list) in most instances to communicate news and events to its' membership. Members can also use the listserv to communicate news and events to the MHCA membership. Each person selected below will be added to the MHCA Listserv.



Subscribe





Invalid Input


Documentation / Information to provide

Please demonstrate your organisations commitment to Mental Health. Supporting documentation, such as your organisation's mission or objective, may be attached or written below.



Write your organisations commitments:

Invalid Input
Attachment (must be pdf , doc, docx, odt and must be under 1Mb):

Invalid Input

If applying for full membership

If you are applying for Full Organisational Membership please provide the following documents.



Your latest Annual Report

Invalid Input
Your Constitution (for Incorporated Associations)

Invalid Input
Other proof of national operations

Invalid Input

Please indicate how the organisation can contribute to the objectives of the MHCA, as illustrated in the organisation's Consitution to;



1. Improve the quality of life for people with a mental illness, carers, and families

Invalid Input
2. Provide a strong and coherent voice for mental health reform and the highest standards of mental health policy and services

Invalid Input
3. Provide strategic leadership to influence policy and funding decisions, especially at the federal level, that impact on the quality of metal health programs and services in Australia

Invalid Input
4. Promote mentally healthy communities

Invalid Input
5. Influence and contribute to meaningful mental health research

Invalid Input
6. Foster a culture of education, learning and development

Invalid Input
Payment for membership should not be sent upon applying for membership. If approved, you will be invoiced for the pro-rata membership fee. (*)

Invalid Input