RAREVOICES Email Marketing -

Application Form - Rare Disease Organisations/Groups

Use this application form if you are representing a rare disease organisation/group.

Before you complete the form, please confirm if RVA Partner fees will be paid from organisational funds *

Yes, the fees will be paid from organisational funds

No, the fees will be borne by an individual

If you answer 'No, the fees will be borne by an individual,' please complete the application form for individuals.

First Name *

Last Name *

Email *

Phone *

State in Australia *

Rare disease *

Organisation *

Postal address *

To the best of your knowledge, are there any other Australian-based support groups representing your patient community? *

Yes

No

Unsure

What are the main activities and goals of your organisation? *

Organisation website *

Is your organisation governed by a board? *

Is your organisation registered as a charity with the Australian Charities And Not-for-profits Commission? *

Is your organisation fully run by volunteers? *

Yes

No

Please disclose any conflicts of interest you/your organisation may have. Please indicate 'none' if you don't have any. *

How did you hear about Rare Voices Australia? *

Please do not submit any sensitive information via this form.

RVA cares about the privacy of your personal information. Please refer to RVA’s Privacy Statement for more information.