AFCA Membership Application July 2010-June 2011

To be eligible for Membership of AFCA you are either

a)    Employed as ‘Detached’ Family /Adolescent & Family Counsellors, whether funded by the Department of Community Services or other funding bodies, or

b)   Employed by community-based agencies and receiving funding from Government bodies, and working in a similar capacity to Detached Family/Adolescent & Family Counsellor, or

c)    A former member of AFCA , or

d)   Employed under similar job descriptions

Members are eligible to vote and hold office, receive newsletters, attend AFCA general meetings, attend and present at AFCA Conferences and Workshops.

Membership benefits include: reduced training costs, AFCA conference and members service listing on the AFCA website & participation in regional AFC meetings.

Name:                    _____________________________                   Current Position Title:___________________________

Employer:              _______________________________________Address:

Postal Address:     _________________________________________________Phone:____________        Fax:____________

Email:_________________________            Web Address:           _________________________________________________

Are you employer a community based management committee?                                  Yes  /   No

How is your project funded?  (Eg. DoCS-CSGP, DoCs-SAAP, FACS,  Anglicare etc)         ____________

Home Phone:________________       Private Address:   ____________________________________

How many hours per month counselling supervision do you have currently?  __________

New applicants please attach resume, detailing qualifications and counselling/therapy experience as well as a copy of your job description.

Membership No:………………..(if known)

Membership fees:

Membership fees are due on the 1^st  July each year.  The fees must be paid before 30^th September for members to be financial. An early bird fee applies if paid prior to August 30^th.

The membership fees are payable as follows:

·        $50.00 per person if paid prior to August 30^th.

·        $65.00 per person between August 30^th and December 30^th

·        Multiple AFC’s in one service - $50.00 early bird fee ($65.00 normal) for the first two AFC’s – subsequent AFC’s @ $25.00 each.

·       These fees are non refundable.

I agree to uphold the A.F.C.A. Code of Ethics and Constitution. Signed: ______________________ Date: ______

Amount Paid: $…………………..  (This form is your tax invoice once paid)

Please make cheques payable to A.F.C.A. or pay direct to St George Bank BSB112 879 Account 043482142 and mail with this form to:

 Payment Type (please circle):     Cheque    or     Credit Card                                                                                                                 

AFCA Inc

Adrian Rizzo (AFCA Membership Officer) Ph: 02 96835107, Fax 96836426,
email afcnuc@bigpond.net.au, Address 3 Hammers Road Northmead NSW 2152