Coeliac Western Australia Food Service Industry Membership Page 1
About Who we are Coeliac Western Australia (CWA) is a not-for-profit organisation established in 1979 to assist and support people who are diagnosed as requiring a gluten free diet for life. CWA is Western Australia s leading support resource with over 1600 members. We are a memberbased organisation and part of the national organisation, Coeliac Australia. CWA receives limited government funding and relies on membership fees, advertising, fundraising and donations to provide services to its members. Why offer gluten free? People eat gluten free for a variety of reasons. For people with coeliac disease, eating a strict gluten free diet is not a choice, but a medical necessity. When people with coeliac disease eat gluten, an inappropriate immune reaction causes inflammation and damage to the small bowel. This ultimately leads to nutrient deficiencies and a number of serious health consequences such as osteoporosis and certain forms of cancer. People with gluten intolerance do not have the same small bowel damage and related health consequences; however they do have physical symptoms upon consumption of gluten including nausea, diarrhoea, fatigue and other gastrointestinal symptoms that may last several days. Whilst at least 1 in 100 people have coeliac disease, it is estimated that between 10% and 20% of people in Australia now follow a gluten free diet for gluten intolerance or other medical conditions. Why become a member? All food service industry members receive the following: Ingredient List booklet - easily identify if an ingredient is gluten free at a glance. Over 1000 ingredients listed. Fact sheets - a variety of fact sheets to assist with providing gluten free options. Advertising discounts - receive discounts on advertising in our quarterly member newsletter, Silly Yak Chat and on inserting brochures into our New Member Kits. (Subject to approval by Coeliac Western Australia) Online restaurant and food stockist directory listing - see page 3 (retailers only) Quarterly member e-newsletter - keep up-to-date on the latest research and news in the gluten free world. Opportunity to participate in our Member Discount Program (see page 6) Page 2
Who can join? Retail shops Food Manufacturers, wholesalers and distributors Caterers or people providing a service for those requiring gluten free - e.g. school tuckshops, hospitals, meals on wheels, retirement villages, nursing homes, etc Online Restaurant, Cafe and Food Stockist Directory Coeliac Western Australia has launched an online Restaurant, Café and Food Stockist Directory. The listing previously consisted of restaurants, cafes and food stockists recommended by members and was only available to current members of Coeliac Western Australia. The online directory is now accessible via our website and is available to the general public, not just members. This will be an invaluable resource for people living in or travelling to Western Australia, who require a gluten free diet. Visit wa.www.coeliac.org.au to view the directory. Each listing includes full contact details, the company logo and website, opening hours and more. Listings are connected to Google Maps, making it even easier for customers to find you. Coeliac Western Australia will be regularly promoting the online directory via our quarterly printed member newsletter, Silly Yak Chat, monthly e-newsletter and Coeliac Western Australia Facebook page. All retailers who are food service industry members of Coeliac Western Australia receive a listing as part of their membership. Please note that there will only be one listing per membership. There is a package deal for franchised stores. Costs Membership is only $75 per year and runs from 1 July to 30 June. A renewal reminder will be sent out in May. For an additional $40 per annum you will also receive quarterly copies of The Australian Coeliac magazine and Silly Yak Chat newsletter. (Optional) How do I join? Simply fill out the Joining Form and sign the Privacy and Consent on the following pages and return them to Coeliac Western Australia via email or fax. Once we have received payment we will post out your new member kit. Page 3
Joining form Food Service Industry Contact details Contact name: Position: Company name: ABN: Phone: Mobile: Email: Postal address: Suburb: State: Postcode: How did you find out about Coeliac Western Australia? Website Customer/client Other: Details to be published online Business name: Address: Suburb: Postcode: Phone: Website: Opening hours: On site parking: Yes No State: Privacy and consent Coeliac Western Australia collects and uses your personal information to provide you with information and services about coeliac disease and the gluten free diet including new gluten free foods. We also use your personal information to compile statistics which assists us to understand coeliac disease better. The information used for statistics is de-identified. Our Privacy Statement tells you how we usually collect and disclose your personal information and how you can ask for access to it. We will disclose your personal information to our mailing house and other relevant contractors with whom we have a Privacy Agreement, so we can provide information to you by post. I agree that my personal information can be used or disclosed by Coeliac Western Australia (CWA) to their mailing house and other relevant contractors with whom CWA has a Privacy Agreement so I can be provided with information relating to the gluten free diet. I hereby apply to become a member of the above named incorporated association. If I am admitted as a member, I agree to be bound by the rules of the association for the time being in force. Signature: Date: / / Page 4
Payment details Membership is $75 per annum I would like to receive the quarterly Australian Coeliac magazine and Silly Yak Chat newsletter for an extra $40 per year (optional) I have enclosed a cheque (made out to Coeliac Western Australia) I would like to pay via credit card (see details below) *A tax invoice can be provided upon request* Please charge $ to my MasterCard Visa Card name Card number Expiry date / Signature Resource order Please send me the following complimentary resources for my customers: Qty Coeliac disease brochure Associated conditions brochure Referral cards Checklist Please ensure you have completed the following before submitting your application: I have enclosed my payment I have signed the privacy and consent (see page 3) I would like to join the Member Discount Programme and have signed and attached the form (Optional see page 6) Email or fax the completed form to wa@coeliac.org.au or (08) 9451 9266 All listings are valid until 30 June 2014 at which time they will need to be renewed. Page 5
Member Discount Program About Coeliac Western Australia has introduced a discount programme for our members as both a benefit for them and a way for businesses to promote their gluten free products. What s in it for me? In return for your generous discount to our members, we will provide you with: A listing in one issue of our quarterly member newsletter Silly Yak Chat, per year A listing on our website as a participant of our Member Discount Programme A link to our Member Discount page on the Coeliac Western Australia website which is promoted in our monthly member e-newsletter Bytes. How do I join? To participate, all you need to do is provide discounts or special offers to our members on presentation of their Membership Card. (Note: There is no fee for participation in this program) You may choose to offer a percentage discount (e.g. 10% off all purchases), buy one get one free or some other special offer. To participate in this program we require a minimum discount of 5% to be offered from the time of commencement to 30 June 2014, after which we will contact you with an option to continue for a further 12 months. Yes, I would like to participate in the Coeliac Western Australia Member Discount Program. The offer I would like to make to Coeliac Western Australia members is: Offer can be redeemed at: To redeem the discount/offer, Coeliac Western Australia members need to: Show member card Use code/password on my website I understand that I will be advised via email regarding participation in this scheme and the commencement date. I understand that I will be required to provide this special offer to Coeliac Western Australia members who present their member card from the date of commencement until 30 June 2014. I understand that I will be contacted prior to June 2014 regarding the continuation of this offer beyond 30 June 2014 and that any continuation will be by agreement between me (or my representative) and Coeliac Western Australia. Signed Date / / Name: Organisation: Return completed form to: Email: wa@coeliac.org.au Fax: 9451 9266 Position Page 6 www.coeliac.org.au