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Organisational Full Membership Form

I represent an organisation whose governing body is madeup of at least 75% of people with disability and we want to be a member of People with Disability Australia Incorporated in the category of FULL ORGANISATIONAL MEMBER

* = This field is Required. Please make sure you fill in each box which has a star * beside it

Representative Full Name*
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Organisation*
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Email Address*
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Address*
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Suburb*
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State or Territory*
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Postcode*
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Country
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Home Phone
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Mobile
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Home Fax
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Work Fax
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I have read and understood the conditions of membership*
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