Prefix

First Name

Middle Name

Surname

Gender

Date of Birth

Organisation Name

Home Phone

Work Phone

Mobile Phone

Fax

Email Address

Secondary Email

Primary Address

Addresses

Faith

Sector

Chapter

Curriculum Vitae / Resume (max. 1 MB)

Completed Qualifications / Training Programs

I declare I have read, understood and will abide by the SCA Mandatory Declarations for Membership for new or renewing members.

I hold a current, appropriate credential for working with children and/or vulnerable people.

Current Working with Children credential details including the state or territory, registration number and expiry date:

I am currently registered or accredited to practice in another professional discipline.

If yes, provide the other professional discipline, name of the registration or accreditation body and registration number:

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