Application Form - Member

Thank you for your interest in Upbeat Arts Queensland. To apply to be a member of one of our programs, please complete this form.
On receipt of your application, we’ll check availability of your chosen program and be in touch with you via the email you provide below.
Our programs are free to access and are delivered for the benefit of adults experiencing a mental illness, or anyone disadvantaged or marginalised. Please include details of the person and organisation who has referred you (and/or supports you), ie Queensland Health; the Agency or Service you are working with or being supported by; or a medical professional.
This Upbeat Arts Application Form collects information to assist us to place you into one of our programs. All information will be treated confidentially and will not be used for any other purpose than what is stated in our Privacy Policy.

Application Form Member

Tell us a little about you

Double check it – and make sure the email address and phone numbers are accurate.
Medical background (please indicate any of the following which apply):(Required)

Program Selection

Which program/s would you like to register for? Choose from the list.:(Required)

For our records

Referrer details

IE this might be Open Minds, RFQ, Queensland Health, an NDIS provider etc
If you don’t have one, please type n/a

Emergency Contact Details

Emergency Contact Name(Required)