Emerge Australia Membership

Please fill in the following details to renew your membership or to apply to 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 that this is an application for membership - if for any reason your application is declined we will inform you directly and provide a refund of your membership fee.

Emerge Australia Membership * Required

applying for membership

renewing membership

Select the appropriate option above

Your Information

Name *

Required

First Name

Required

Last Name

Email * Required

Phone * Required

Address *

Required

Street Address

Required

City

Required

State

Required

Postcode

Required

Country

Date of Birth

dd/MM/yyyy

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

Each member pack includes a welcome letter, various fliers for our services, an invisible disability lanyard and an Emerge Australia supporter wristband. You will also receive a digital version of the annual Emerge Australia journal once available.

* Required

Yes, please send me a complete member pack

No, please do not send the member pack

I am a * Required

Person with ME/CFS

Carer of someone with ME/CFS

Family member of someone with ME/CFS

Friend of someone with ME/CFS

Health Professional

Other

Amount * Required

$5 - Membership (Financial Hardship)

$50 - Membership

Additional Optional Donation

Total Due

Total Due * Required

Stripe AUD

$ Amount to be paid $

Name on card

Please check this box if you would not like to receive direct solicitation

Do not solicit

Please note: In the unlikely event a "critical fail" message appears after you complete your transaction, please be assured that your membership has been processed.

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