Join The ACT DSA


ACTDSA Membership Application Form

This year we are pleased to announce that ACTDSA will be offering free membership for the 2018-2019 financial year.

This free membership trial offer aims to broaden our reach within the Canberra region and to ensure everyone in our community has equal access to ACTDSA’s services, information, and events.

Please fill out the form below to get your membership underway. Please fill out Part A, Part B (if applicable) and Part C. If you have any questions about filling out this form, please contact the office on 02 6290 0656 or

Once your membership is approved, you will be sent a welcome email containing all the necessary information about the Association.

We look forward to welcoming you as a member of the Association!


Part A

Applicant(s) Full Name

Relationship to Person with DS

Name of Person with DS

Date of Birth of Person with DS

Family Member / Organisation Postal Address

Mobile/Telephone (business hours)

Mobile/Telephone (after hours)

Email Address (Required)

Second Email

Part B (for people over 18 with DS)

Applicant’s Name

Date of Birth

Applicant’s Postal Address

Applicant’s Mobile /Telephone

Applicant’s Email Address

Member of Confident Speaker Program?


Name of Responsible Adult/Carer

Relationship to Person with DS

Responsible Adult/Carer’s Phone(s)

Responsible Adult/Carer’s Email(s)


Part C

What activities would you be interested in the DSA organising, hosting and/or sponsoring?

What are your main areas of interest in relation to Down syndrome? (ie particular life transitions? Age-related issues? Social aspects?)

Please indicate those areas you would like to receive information about:
Education – PrimaryEducation – Early learningEducation – High SchoolEducation – Vocational Training and ApprenticeshipsEducation – UniversityEmploymentIndependent LivingLegal IssuesBehavioural Issues and StrategiesDepression and AnxietyAutism Spectrum DisordersSleepBreastfeedingToilet trainingSporting OpportunitiesDanceMusicMoviesArtsConfident SpeakersRecent ResearchConferences and WorkshopsParent RetreatsRespiteAgeing and Down syndromeNDIS


What skills would you like to bring to the ACTDSA? We understand that not everyone has time to commit in a major way, but if you have a particular skill set or willingness to commit to the Association in some small way on a regular or irregular basis, we would be hugely grateful (eg. committee membership, new parent or member support, workshop assistance, graphic design, event assistance eg sausage sizzling or face painting, fundraising skills, grant writing, attendance/participation at ACTDSA functions, etc).

Thank you for taking the time to complete this part of the application process.