"Knowing that I am not alone helps more than I can explain"

Membership Form
    Please tick a box
            0 person with a disability
            0 the parent, sibling or relative of a person with a disability
            0 friend and/or advocate
            0 professional
            0 interested in the work of ACTION
            0 I understand and support ACTION’s vision and objectives

Membership fees
    New membership begins on the 1 July of each year

            Individual annual fee      Waged $10.00
                                    Not waged       $5.00  
            Individual five year fee  Waged $35.00
                                    Not waged       $15.00
            Family annual fee          Waged $15.00
                                    Not waged       $7.50
            Family five year fee       Waged $55.00
                                    Not waged       $30.00
Donation
    Donations over $2 are tax deductible (Charity CFN 12314)
            I wish to make a donation of …………
           
Contact details
    Name           ………………………………………………………..
    Address       ………………………………………………………..
……………………………Postcode……………….
    Email            ……………………………Phone…………………..
    Signed          ……………………………Date…………………….