Patron Membership Application

It is a relatively easy process to become a Patron 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 does need to be approved by the board. You will be issued a certificate of Patronage 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.

Patrons are specialised members that directly assist HelpStop’s ‘big picture’ in the promotion of HelpStop within the wider community. Particularly using their extensive influence across a broad section of the Australian community.

Holding luncheons etc. for invited guests to hear about our harm prevention program
Be the master of ceremony at a charity ball or other fundraising events
Use your own platform, twitter, linkedin etc. to promote HelpStop.

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 Patron Member of HelpStop because: *

How I can be of assistance to HelpStop:

I have experience in the following areas:

Date of Application: *

Signature: *

References to Fill Out

First Reference

Reference's Full Name: *

Reference's Number: *

Reference's Email: *

Relationship to Yourself: *

Second Reference

Reference's Full Name: *

Reference's Number: *

Reference's Email: *

Relationship to Yourself: *

Third Reference

Reference's Full Name: *

Reference's Number: *

Reference's Email: *

Relationship to Yourself: *

HP: