DOG GUIDE HANDLERS AUSTRALIA. (Inc).

Application for Membership.

Dog Guide Handlers Australia (DGHA) is an independent national association which fosters, represents, promotes and protects the interests of Australians who are blind or vision impaired, who use a dog guide.

You must be over 18 years of age to join as a full member of DGHA.

Membership is in two categories:
1). Full membership:
Any Australian who is blind or vision impaired and is a dog guide handler.  

2). Associate Membership:
Any person who is sighted, blind or vision impaired, who supports the purpose of DGHA.

It is requested that membership forms are completed electronically, that is, typed responses, and submit as an attachment via email. An on-line membership application form can also be found at http://dgha.org.au/dgha/membership/

Please send completed forms to: dgha@dgha.org.au

Please answer all sections which apply to you, by typing your responses in the space provided.

SECTION 1:   FULL MEMBERSHIP.
Please complete this section if you are an Australian resident who is blind or vision impaired, and you use a dog guide and you wish to apply for full membership to DGHA.

FULL NAME:		
Date of Birth:		
EMAIL ADDRESS:		
TELEPHONE: (include area code)		
MOBILE TELEPHONE:		
POSTAL ADDRESS: 
(Street or PO Box).		
Suburb:		
State:		
Postcode:		
Your dog is also trained for:		
Name of dog guide:		
Breed of Dog:		
Name of dog guide school:		

SECTION 2: ASSOCIATE MEMBERSHIP:
Please complete this section if you are a person who is sighted, blind or vision impaired, who supports the purpose of DGHA

FULL NAME:		
Date of Birth:		
EMAIL ADDRESS:		
TELEPHONE: (include area code)		
MOBILE TELEPHONE:		
POSTAL ADDRESS: 
(Street or PO Box).		
Suburb:		
State:		
Postcode:		
Country:		

SECTION 3: Please complete this section if you work for a Dog Guide, or other blindness organisation:

Name of dog guide or other blindness organisation:		
Position Title:		

SECTION 4: Please complete this section if you are a Puppy Raiser:

Name of Puppy:		
Breed of Puppy:		
Name of dog guide school:		
Please submit your completed application form electronically via email to;
dgha@dgha.org.au  
Your application will be acknowledged by the DGHA committee, and you will receive a receipt to confirm your membership, after payment of the applicable membership fee has been received.

The current membership fee is a once only payment for lifetime membership:
Full Membership: $20.00.
Associate Membership: $10.00.

Membership fees may be paid by electronic funds transfer:
Account Name: Dog Guide Handlers Australia. 
Bank:  ANZ Bank
BSB Number: 016484  
Account Number:   268410756
Payment description:   
To identify your payment and ensure that we enter it in our database correctly, please make sure to include the descriptor “Mship” and the initial of your first name, and your full last name in the payee description provided by your bank.  If your bank does not allow this, please use your phone number as the descriptor.

Thank you 
Secretary 
Dog Guide Handlers Australia