Supporter application Become a supporter 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 firstname.lastname@example.org. Supporter application form Step 1 of 6 16% Supporter type(Required)SelectOrganisationIndividualAcceptance of Embolden’s objectives, purpose and values(Required)For more information, read our constitution We have read and agree with the objectives, purpose and values Acceptance of Embolden’s objectives, purpose and values(Required)For more information, read our constitution I have read and agree with the objectives, purpose and values Select the size of your organisation(Required)SelectSmall (>$600,000)Medium ($600,000-$3m)Large ($3m-$10m)Enterprise ($10m+)Select your current employment status(Required)SelectFull time employeePart time employeeConcession & UnemployedEmployee of a Sector/Associate member organisationHiddenCost HiddenFee Type HiddenPro-rata costHave you been affected by hardship?Embolden reserves the right to waive subscription fees for people with lived experience of gender-based violence, hardship or other special considerations I have been affected by hardship Annual ‘–‘ ongoing supporter cost $– Supporters are invoiced on 1 July of each year You’ll be charged $– for the remainder of the current year. Embolden welcomes a discussion about appropriate fees and offerings for enterprises with a turn over greater than $10 million. Please email us at: email@example.com.Your fees will be waived for the remainder of this financial year. When it comes time to renew your supporter membership, you will be given the option to continue to waive your fee for the next financial year. These details are used for us to contact you directly. None of your details provided below will be published anywhere without your permission.Your name(Required) First Last Allow your full name to be published as a supporter of Embolden? (optional)Your name will not be published on our website, only in internal documents and annual reports. Yes, you may publish my name Pronouns(Required)Selectshe/herthey/themhe/himzie/hirOtherYour pronouns(Required) Phone(Required)Mobile or direct preferredEmail(Required)News and other information from Embolden will also be sent to this address. Password(Required)Used to log into the member area and manage your details on this website. Strength indicator Postal address(Required)Used for supporter communication Street Address Address Line 2 City State Post code Organisation name(Required) Website LogoIf 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.Allow your organisation's name and website to be published as a supporter of Embolden? (optional) Yes, you may publish our name and website Reasons for supporting Embolden(Required) Advocacy Training News Events Other Other reason(Required) Would you like to be contacted about volunteering with Embolden?SelectYesNo Supporter fee summary Annual ‘–‘ membership cost $–/year Memberships are invoiced on 1 July of each year Add 'Voices for Change' honorarium/s (+$75.00 per honorarium)Embolden facilitates the ‘Voices for Change’ program which engages audiences and offers deep insight into the complexities of violence in our communities. Advocates share personal stories of abuse, trauma, survival, hope and strength.Pro-rata membership cost due (membership until 1 July) Price: $ 0.00 'Voices for change' honorarium/s Price: $ 0.00 HiddenTotal for validationHiddenGSTTotal cost today (inc. GST) $ 0.00 Payment details(Required)Card Details Cardholder Name Any questions, comments or feedback?Consent(Required) I have read and agree to the terms and conditions EmailThis field is for validation purposes and should be left unchanged.