Men of Central Australia need your support

Support us by becoming a financial member

Application for Membership

Name _____________________________________________
.
Address _____________________________________________
.
Phone ______________________ Fax__________________
.
Email __________________________

 

I am applying to become a member of Men's Health Central Australia
.
I agree to support the aims and objectives and be bound by the rules of the group
.
I enclose $____________ for my 12 month membership
  • $15 Low Income/unwaged
  • $25 Full Wage
  • $30 Organisation
.
Signature:____________________ Date:__/__/____

 

To apply for membership, print out this page, complete the details, attach your cheque or money order and mail to:

The Treasurer
Men's Health Central Australia
PO Box ????
Alice Springs NT 0870