Community Membership Application

It is a relatively easy process to become a Community Member of HelpStop, however to abide by our constitution four things must be completed.

Fill out the application form provided by HelpStop. The application should include your contact details, your reasons for applying
By submitting an application you agree to have read and understood HelpStop's constitution, privacy policy, Non Conduit policy and code of conduct.
Your application goes before the board for approval. The yearly membership fee of $104 must be received. On approval HelpStop’s customer care team will contact you directly and organise the payment either as a bank transfer or a credit card payment. You will be issued a certificate of community membership which will include your membership number via email.
After receiving your membership certificate, the Customer care team will get in touch with you. They will discuss how you wish to be involved with HelpStop and provide suggestions on how you can assist them in their efforts to mitigate the harm caused by gambling.

Please Fill In All Required Fields

First Name: *

Middle Name:

Last Name:

Address:

Landline:

Mobile Number:

Email:

Date of Birth: *

I wish to become a Community Member of HelpStop because: *

How I can be of assistance to HelpStop:

I have experience in the following areas:

Date of Application: *

Signature: *

Reference's Full Name: *

Reference's Number: *

Reference's Email: *

Relationship to Yourself: *

Reference's Full Name: *

Reference's Number: *

Reference's Email: *

Relationship to Yourself: *

Reference's Full Name: *

Reference's Number: *

Reference's Email: *

Relationship to Yourself: *

HP: