QWaLC Membership Application "*" indicates required fields Step 1 of 8 12% Name of Person Completing this Application* First Last Legal Entity or Other Type*Incorporated AssociationCompanyCooperativeIndigenous CorporationUnincorporated GroupIs your group endorsed as a deductible gift recipient (DGR)? Yes No DGR Information can be found by clicking hereIs your group registered as a charity with the ACNC? Yes No If you are unsure click here to find out.Group Name:*As it appears on your certification of incorporationABN*If you don't know your ABN look it up at: https://abr.business.gov.au or if you haven't received one yet just enter 11 zeros.Group Name:*Incorporated Association ID (if applicable)If you don't know your IA identification look it up at: click here.Enter the name of your auspice organisation (if applicable)Which best describes your group:*Catchment Management GroupCitizens or Residents AssociationCluster Fencing GroupCoastcare GroupCommunity FarmCommunity GardenEnvironment CouncilField NaturalistsIndependent ForumIndigenous GroupIndustry GroupLandcare GroupNative Plant NurseryNature ConservationPermaculture GroupRegional NRM GroupResearch OrganisationWildlife Preservation GroupBriefly outline your group’s objectives and purpose (max 250 characters)* In which LGA Area and NRM Region is your group located ?Local Government Area*Aurukun ShireBalonne ShireBanana ShireBarcaldine RegionBarcoo ShireBlackall-Tambo RegionBoulia ShireBrisbane CityBulloo ShireBundaberg RegionBurdekin ShireBurke ShireCairns RegionCarpentaria ShireCassowary Coast RegionCentral Highlands RegionCharters Towers RegionCherbourg Aboriginal ShireCloncurry ShireCook ShireCroydon ShireDiamantina ShireDoomadgee Aboriginal ShireDouglas ShireEtheridge ShireFlinders ShireFraser Coast RegionGladstone RegionGold Coast CityGoondiwindi RegionGympie RegionHinchinbrook ShireHope Vale Aboriginal ShireIpswich CityIsaac RegionKowanyama Aboriginal ShireLivingstone ShireLockhart River Aboriginal ShireLockyer Valley RegionLogan CityLongreach RegionMackay RegionMapoon Aboriginal ShireMaranoa RegionMareeba ShireMckinlay ShireMoreton Bay RegionMornington ShireMount Isa CityMurweh ShireNapranum Aboriginal ShireNoosa ShireNorth Burnett RegionNorthern Peninsula Area RegionPalm Island Aboriginal ShireParoo ShirePormpuraaw Aboriginal ShireQuilpie ShireRedland CityRichmond ShireRockhampton RegionScenic Rim RegionSomerset RegionSouth Burnett RegionSouthern Downs RegionSunshine Coast RegionTablelands RegionToowoomba RegionTorres ShireTorres Strait Island RegionTownsville CityWeipa TownWestern Downs RegionWhitsunday RegionWinton ShireWoorabinda Aboriginal ShireWujal Wujal Aboriginal ShireYarrabah Aboriginal ShireNatural resource management region location:*Burnett Mary (BMRG)Cape York NRM/Torres StraitCondamine (SQ Landscapes)Desert ChannelsFitzroy BasinGulf Savannah NRM/Southern GulfMurray Darling (SQ Landscapes)NQ Dry Tropics/Reef CatchmentsSEQ (Healthy Land & Water)SW QLD (SQ Landscapes)Wet Tropics (Terrain NRM)StatewideNationalIf you are unsure consult the map: https://qwalc.org.au/Human Resources Total number of Employees (F/T, P/T, Casual), Members, Volunteers and Total number of volunteer hours performed each monthFull-Time*Part-Time*Casual*Members*Volunteers*Hours/Month* Select the activities your group undertakes:* Accredited Training Annual Expo or Conference Community Gardening Consultancy or Advocacy Development/Publication of Printed Materials Eco-Tourism Activities (Cultural or Nature Based) Education and/or Outreach Services Fencing Feral Animal Control/Monitoring Fire Management GIS Mapping Services Hiring out of Facilities or Equipment Litter Removal Marine Area Conservation Production of Edible Plants Production of Native Plants Scientific Research Sustainable Agriculture Production Practices Vegetation Management (Weed control, tree planting etc.) Water Health Monitoring Wildlife Monitoring Wildlife Rescue/Rehabilitation Workshops/Field Days Other Add other activities not listed above Add Remove(A maximum of 5 activities can be added)What income generation activities does your group engage in?* Auspice Fees Consultancy or Advisory Services Contract Fencing Facility/Equipment Hire Feral Animal Control/Monitoring Fund Raising Events (Expos, Conferences, Raffles, Market Stalls etc.) GIS Mapping Membership Fees Native Plant Sales Project Management or Administration Sale of Printed Materials (eg: Books) Sale of Produce (eg: Fruit/Vegetables) Training Events (eg: Workshops/Field Days) Vegetation Management (Weed control, tree planting etc.) Water Quality Monitoring We don't generate income Other Add other activities not listed above Add Remove(A maximum of 5 activities can be added) Does your group auspice any unincorporated groups or sub-groups?* No Yes List the organisations that you auspice below: Add Remove(List up to 5 groups)Does your group work with any other natural resource management groups (e.g. landcare, bushcare, catchment management)?* No Yes List the organisations that you work with below: Add Remove(List up to 5 groups)Does your group have a copy of, and use, 'In Safe Hands' Toolkit from www.insafehandstoolkit.com.au?* Yes No Using the space below please clearly describe the WH&S policies and procedures (or system) you use to manage risk*Insurance coverage cannot be provided to Groups that do not have and implement risk management policies and procedures. Does your group require insurance coverage?* Yes No The following information is required for insurance purposes (annual totals)Income*Expenses*Assets*Liabilities*Your Group's Address(If you do not have a physical address you must enter a location that includes the suburb/town, postcode and state.) Street Address Address Line 2 Suburb/Town State Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Your Group's Primary Contact PersonFirst Name*Last Name*Position*Phone*Email* Your Group's Website, Email and Social Media DetailsWebsite Email* Facebook Instagram Twitter Linkedin Please attach a copy of your organisation's constitution*Max. file size: 64 MB.Please attach a copy of your organisation's certificate of incorporation*Max. file size: 64 MB.Information Collected* I understand and agree to the following:Personal/group information collected on this application form will be used to assess our group's application for membership as a Landcare/ NRM volunteer group. It will be disclosed to Queensland Water and Land Carers and relevant organisations as part of the assessment process. In the event that your application is successful, this information may also be disclosed to our insurers in connection with their provision of insurance covering the legitimate activities of the group. Group information will be displayed on the QWaLC website.Authorisation* I declare that I am a member of the Management Committee (or Board) and have the authority to submit this application for QWaLC membership on behalf of my group.Insurance Declaration* I hereby declare that as of today’s date we have no outstanding claims and after enquiry there are no circumstances which may result in a claim that has not already been notified to the insurer.
