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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 

* = This field is Required. Please make sure you fill in each box which has a star * beside it
Representative Full Name *
Organisation *  
E-mail address *  
Address *
Suburb *  
State or Territory *
Postcode *  
Home Phone:
Home Fax:
Work Phone:
Work Fax:
I have read and understood
the conditions of membership *
Yes I have

As a Organisational Full Member of People with Disability Australia,
you get PWDA Media Releases and our monthly EBulletin by email.

You can also choose to get one or both of following by email.
Please tell us if you want to get one or both by ticking the box:
PWDA Alerts  (short, single-issue news items)
Daily Media Roundup  (daily roundup of disability-related news items)

All information collected by PWDA is protected by the Privacy Amendment (Private Sector) Act 2000 (Cth)