Join Us

Become a member of Pierre Robin Australia Inc today and receive ongoing information, support and education along with full access to functions, social events and our online forum where you can connect with other families living with PRS.

Anyone can join and best of all... membership is FREE.

Simply complete the online application form below. It’s that simple.

Creating a united PRS community is the most important part of what we do, bringing families and carers together to help support one another.

NB: Cost of annual membership is currently under review by the Pierre Robin Australia Inc committee of management.

(03) 9789 9373

email us

Username *
Password (min. of 6 characters for both Username and Password) *
Please Select *	I am a parent I am a grandparent I am a carer I am a friend or relative I am a medical professional I am a specialist or service provider I have PRS Other
Surname *
Given Name *
Childs Surname *
Childs Given Names *
Gender *
D.O.B *
Childs Diagnosis *
Mothers Surname *
Mothers Given Names *
Fathers Surname *
Fathers Given Names *
Sibling 1 (full name)
Sibling 2 (full name)
Sibling 3 (full name)
Sibling 4 (full name)
Street Address 1 *
Suburb *
Postcode *
State *
Street Address 2: (if applicable)
Suburb
State
Postcode
Phone: (H 1) *
Phone: (H 2)
Phone: (Mb 1) *
Phone: (Mb 2)
Phone: (optional ie: work)
Email 1 *
Email 2
Would you like to: (please tick)	Join our forum Be emailed newsletters, updates and information Attend social functions Register as a volunteer or fundraiser at and for events Join our committee
How can PRAISE best assist you and your family?
Further comments or suggestions?
How Did you hear about us?	Your doctor/medical facility Google Facebook
Other services: please advise
By completing the above details, I agree that I am registering all individuals listed to become members of Pierre Robin Australia. I am aware that my personal details will be kept confidential at all times and that i may resign my membership at anytime. *