FREE WORKSHOP BOOKING FORM

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Select your Booking Type? *

Select type of application?

A membership renewal is much more simplified process for our existing members. New Members must complete the New Membership to provide all of the necessary information for review.

Select the type of Membership for this application *

Memberships are non refundable. Family memberships can consist of up to 2 adults, 2 children living at the same address

Family Membership - Select Members of family

Secondary Adult Member
Child (1st)
Child (2nd)

Family memberships allow for up to four household members to apply under the family membership option.

Name (Primary Member) *

First

Last

Mobile Number (Primary Member)

Date of Birth *

Email (Primary Member) *

Membership Number *

Please provide your membership number which has been sent to you via email when you renew or join as a member.

Family Membership (Secondary Adult Member)

Secondary Member Name (Family Membership Only)

First

Last

Only complete this section if you selected the family member application type option.

Mobile Number (Secondary Member)

Email (Secondary Member)

Leave empty if not applicable.

Date of Birth (Secondary Member)

Leave empty if not applicable.

Family Membership (Children)

Child Name (First)

First

Last

Please complete to add any children to the application for a family membership application only

Child Date of Birth (First)

Leave empty if not applicable.

Child Name (Second)

First

Last

Please complete to add any children to the application for a family membership application only

Child Date of Birth (Second)

Leave empty if not applicable.

Personal Information

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Emergency Contact Name (For Primary Member) *

First

Last

Emergency Contact Relationship *

Phone

Has your address changed since your last application?

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Are you planning on attending the workshop with any "Members" that are under your existing "Family Membership"?

Please include all names of additional Members you are booking for:

General Background & Experience

Are you a current member or been a member of another wildlife organisation? *

Have you ever been denied a Wildlife Rehabilitation Permit or had one cancelled or revoked by either a wildlife organisation or the DES (Department of Science)? *

Please identify the wildlife organisation you are a member or have been a member of below

If you answered No to the previous question please leave this field blank.

Please describe, if any, your previous wildlife experience?

Please leave blank if you do not have any experience.

Have your emergency contacts changed since your last application?

Emergency Contact Name Update

Emergency Contact Relationship

E.g. Husband/Wife/Mother/Father/Brother/Sister etc.

Emergency Contact Phone Update

Select 'Free' Members Workshops you will be attending with us?

2 HOUR FREE INFORMATION SESSION -- SUNDAY 18TH MAY 2025 -- 10AM-2PM -- LOCATION: BEERWAH, TBD
INDUCTION TO POSSUM WORKSHOP -- SUNDAY 25TH MAY 2025 -- 9AM-4PM -- YOU MUST BE A MEMBER TO ATTEND THIS SESSION

Location of workshops are in Beerwah. TBA

Payment & Complete Form Submission

Please select your preferred payment method *

For ETF/Bank Transfers Please use Westpac Bank - Account Name: Wildlife SEQ Inc. - BSB Number: 034 243 - Account Number: 365 050

Select Membership Type for Secure Credit Card Payment

Please manually select the membership type from the dropdown list.

Secure Credit Card Payments Online (Square Payments) *

Card

Name on Card

Square Payments Provider supports WildlifeSEQ Inc with secure online payments for our members. WildlifeSEQ Inc does not collect, store or process your credit card details.

Total

$0.00

Bank Account Transfer

Use the following Bank Account Information for transfer via EFT/Deposit – Westpac Bank – Account Name: Wildlife SEQ Inc. – BSB Number: 034 243 – Account Number: 365 050

By becoming a member of Wildlife SEQ Inc. you agree to: 1. Abide to all content included in all workshop manuals when carrying out any tasks on behalf of Wildlife SEQ Inc. 2. Abide by the organisations core values, policies and procedures 3. Agree to follow and adhere to Wildlife SEQ Inc. Safety Practices 4. Abide by the rules set out in the following legislation (policy will be emailed) - Code of Practice – Care of Sick, Injured or Orphaned Protected Animals in Queensland As part of our application process Wildlife SEQ collects personal information and matter including name, address, phone number, email address, training and experience. This information may be released to other relevant wildlife organisations including but not limited to Australia Zoo Wildlife Hospital, Department of Science (DES), RSPCA if required. Wildlife SEQ Inc. accepts no liability for any personal injury, death, property damage/loss or financial cost arising from any voluntary work undertaken on behalf of the organisation. Wildlife SEQ Inc. holds Public Liability Insurance in the amount of $20,000,000. *

I accept the above terms & conditions

Are you interested in any of the following volunteer roles?

Wildlife Carer
Animal Transportation
Wildlife Rescue

Our Wildlife Needs your Help!!! WildlifeSEQ Inc. are recruiting volunteers for the abovementioned roles. Please select any or all that you would be interested in and we will reach out to you with further information at a later time.

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