Membership application

Our vision and values

Our vision is for ‘a society based on equity and respect for all women, in a world free from violence.’

Our values are freedom, equity, respect and safety.

Safety
- Women and children have a fundamental right to safety
Freedom
- Women and children have a fundamental right to freedom from violence
- Women’s rights to self-determination are upheld
Equity
- Services for women and children are accessible
- Service provision is equitable and non-discriminatory
- Systemic barriers are recognised and dismantled
Respect
- Services are responsive to diverse needs and cultural experiences
- Services work collaboratively and actively to support integration
- Perpetrators are held accountable
- Services are transparent and accountable
Please demonstrate how your service or organisation meets the objectives and criteria of Embolden SA Inc(Required)
Acceptance(Required)
- We agree with the objectives, purpose and values
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Membership type

The application process

Next, we need to know more about yourself and your organisation in order to determine your eligibility to join Embolden. Please fill out the following form to the best of your knowledge. If you’re unsure or have any questions about how to proceed, please contact us at [email protected]

Please note that Sector and Associate Member applications are subject to Board approval. We appreciate your patience while your application is being processed. Sector and Associate Member applications are subject to Board approval. We appreciate your patience while your application is being processed.

Upon acceptance of your membership application, you will receive a provisional welcome email with an invoice for the pro-rata coverage of your subscription until the end of the financial year. After payment is received, we will send you a Membership Pack providing you with access to all the benefits of your Embolden membership.

If you have any questions about the application process, please contact [email protected]

Select the size of your organisation(Required)
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Cost
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Organisation size
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Pro-rata cost
Annual ‘–‘ membership cost

$–

Memberships are invoiced on 1 July of each year

Upon approval of your membership, we will send an invoice for $– for the remainder of the current year.

These details are used for us to contact you directly and manage your membership. None of your details provided below will be published anywhere without your permission.
Your name(Required)
First Last
Pronouns(Required)
Your pronouns(Required)
Phone(Required)
Mobile or direct is preferred
Email(Required)
News and other information from Embolden will also be sent to this address.
Postal Address(Required)
Used for membership communication

Address Line 1 Address Line 2 City State Post code
Proxy member
- I would like to nominate a proxy member with my application
Proxy member name(Required)
First Last
Proxy member pronouns(Required)
Proxy member pronouns(Required)
Proxy member phone(Required)
Mobile or direct is preferred
Proxy member email(Required)
News and other information from Embolden will also be sent to this address.

Applications for Sector membership must include contact details for two current financial Sector members who have agreed to endorse this application. Please provide these details below.
Sector member endorser 1(Required)
Enter the organisation name below
Sector member endorser 2(Required)
Enter the organisation name below
Endorsement confirmation(Required)
- I have confirmed endorsement from the above members and understand that they will be contacted in order to progress my membership application

If your membership is approved, the details provided below will be published in the listing on our members page.
Service or program name(Required)
e.g. Bramwell House
Lead organisation name
If the program has a lead organisation e.g The Salvation Army
Short description of the service or program(Required)
Website
Logo
If you are having issues uploading a logo in the correct format or size, feel free to skip this. Our Membership Engagement Officer can assist with this after your application has been approved.
Accepted file types: jpg, jpeg, png, Max. file size: 2 MB.

If your membership is approved, the details provided below will be published in the listing on our members page.
General phone number
Include alternative phone
- Add an alternative/special phone number e.g. a helpline or after hours
Additional phone number description(Required)
e.g. ‘Helpline’ or ‘After hours’
Additional phone number(Required)
Email address

If your membership is approved, the details provided below will be published in the listing on our members page.
Region/s the service or program operates in(Required)
Click into the box again to select more than one region
Service or program address
Only fill in the fields that you’d like to have publicly listed. E.g. you may want to exclude street-level detail

Address Line 1 Address Line 2 City State Post code
Second address option
- List a second address
Second address
Only fill in the fields that you’d like to have publicly listed. E.g. you may want to exclude street-level detail

Address Line 1 Address Line 2 City State Post code

If your membership is approved, the details provided below will be published in the listing on our members page.
Select services from this list that apply to your organisation
Are we missing a service you provide?
Type them into the box below for consideration.

If your membership is approved, the details provided below will be published in the listing on our members page.
Days the service/program is open or available
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
- Sunday
Monday operating hours(Required)
Click on the field to set the hours. Set both start and end times to ’12:00am’ for 24 hours
Tuesday operating hours(Required)
Click on the field to set the hours. Set both start and end times to ’12:00am’ for 24 hours
Wednesday operating hours(Required)
Click on the field to set the hours. Set both start and end times to ’12:00am’ for 24 hours
Thursday operating hours(Required)
Click on the field to set the hours. Set both start and end times to ’12:00am’ for 24 hours
Friday operating hours(Required)
Click on the field to set the hours. Set both start and end times to ’12:00am’ for 24 hours
Saturday operating hours(Required)
Click on the field to set the hours. Set both start and end times to ’12:00am’ for 24 hours
Sunday operating hours(Required)
Click on the field to set the hours. Set both start and end times to ’12:00am’ for 24 hours

Membership fee summary

Annual ‘–‘ membership cost

$–/year

Memberships are invoiced on 1 July of each year

Upon approval of your membership, we will send an invoice for $– for the remainder of the current year.
Any questions, comments or feedback?
Consent(Required)
- I have read and agree to the terms and conditions
Comments
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Become a member

Member application form

Step 1 of 11

Our vision and values

The application process

Membership fee summary

24 hour on-call service
24/7 support
Aboriginal and Torres Strait Islander culturally appropriate support
Accommodation assistance
advocacy
Case management
children's support services
Community education
Counselling
Crisis accommodation
Culturally and linguistically diverse support
culturally sensitive support
Domestic and family violence support groups
Domestic Violence Disclosure Scheme
Early intervention
Financial assistance
Financial counselling
Housing and homelessness support
Information and referrals
interpreting service
Intervention order information and support
Legal aid
Legal assistance and referral
legal information and referrals
legal representation
Low income support
Men's behavioural change
Men's services
mental health support
Outreach
outreach services
pets
Post-separation support
redress support
restorative justice
Risk assessment
Safe at home support
Safety planning
SARTI
Sexual assault services
short term emergency accommodation and help to find sustainable safe housing
Support groups
Training and education
Trauma counselling
Women's Safety Contact Program
Youth services