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Queensland Wildlife Rehabilitation Council

Membership Application

This Application form is for new memberships and membership renewals

A new form is required each membership (calendar) year to validate your insurance cover.
Applications received after 1 October each year expire 31 December of following year.

Please complete all details that are marked required. (ONLY ONE PERSON PER APPLICATION. Minimum age of applicant is 15 years of age).

Payment details are at the bottom of form.


















































    Virtual signature






    A new form is required each membership (calendar) year to validate your insurance cover.
    Applications received after 1 October each year expire 31 December of following year.