Feminist Local Action Group Sign Up Form I would like to (tick all that apply):* join a FLAG in my local area start my own FLAG Do you know the name of your local FLAG? Please specify here if you do.MembershipYou must be a YWCA Australia member in order to join a Local Action Group. Membership is FREE and includes a range of benefits, which you can check out here. Please indicate:*I am already a memberI agree to becoming a memberI am unsure if I am a memberDisclaimer*Yes I doNoDo you accept the values of YWCA Australia and agree to be bound by the terms of membership in the YWCA Australia Constitution? *Personal InformationFull Name* First Last Contact Email:* Contact Phone*Date of Birth* DD MM YYYY Address* Street Address Address Line 2 City State Postcode Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe About YouGender*FemaleMaleNon-BinaryOther (describe below)Prefer to Self DescribeThe following question is optional. We use this information to understand more about our membership, which will help us inform our membership activities, our advocacy, and our service delivery.Do you identify with any of the following: Aboriginal and/or Torres Strait Islander Culturally and linguistically diverse Living with a disability LGBTIQ+ What issues are you interested in? (multiple choice)* Feminist Activism Gender Equality Social enterprise (like our Song Hotel) YWCA Global Movement Gender Policy Gender-Based Violence Young Women's Leadership Housing and Homelessness Climate Justice Sexual and Reproductive Health and Rights Women's Economic Security Intersectional Feminism Other Please provide more informationDo you have any skills or experience you would like to contribute to a Local Group?How did you find out about YWCA Local Groups?Volunteer InformationAll YWCA Local Group members are defined as volunteers in order to ensure that they are covered under our organisational insurance policy. To quality as a volunteer, please provide the following information.Are you prepared to obtain a Police Check or Working With Children check if working with young people?*YesNoI already have a valid checkVOLUNTEER CONSENT: I consent to the collection of my personal information as contained on this form and acknowledge that this information will be held and used in accordance with the relevant YWCA Australia policies, including in order to assist YWCA Australia to identify mutually suitable volunteering opportunities. I understand that YWCA Australia may require me to attend an interview, as well as complete pre-engagement checks such as a National Criminal History Check and any other workplace checks that are relevant to the volunteer role and working with children. I understand that I will not be able to commence in my volunteer role until any required checks have been completed, or continue if those checks expire. I understand that by ticking the consent box below and submitting this form, I am consenting to these terms. Consent* I consent to the above terms and conditions.Emergency Contact DetailsEmergency Contact Name* First Last Relationship to you*Emergency Contact Phone*Emergency Contact Email* ConsentBy providing your email address and/or mobile number you agree to receive information from YWCA Australia about local groups from time to time via electronic means. If you do not wish to receive information via electronic means please email [email protected] to let us know.Consent* I consent to the above terms and conditions.