membership form

Category

.... Organisations $50.00

.... Professionals $25.00

.... Parent and family members (if working) $25.00

.... Parent or family members (if on Centrelink payments) $2.00

Please tick one category

your details

Name/title.........................................................................................................................................

Postal address................................................................................................................................

............................................................................................................................................................

............................................................................................................................................................

Telephone number...................................    E-mail address......................................................

Method of payment

Cheque to be made payable to: Family Inclusion Network NSW Inc.

Internet banking to: Westpac 032069 293426. Make sure your name is shown against the payment.

Print your own receipt.

Send cheque or money order to:

GPO Box 733

Surry Hills

NSW 2010