Become a
member
The Hepatitis C Council of South Australia provides information, education and support to the hepatitis C community and those at risk. A strong membership of people affected by the virus is essential to our work. Complete the form below and send it to us by post: PO Box 782, Kent Town SA 5071 or fax: (08) 8362 8559.
Your details Member type (tick one) Title
New
Renewing
Name
Occupation Organisation (if applicable) Mailing address
Postcode
Phone Fax Email
Membership type (tick one) Non-waged Waged Organisation Application for zero cost
$5.50* $16.50* $55* $0*
* All prices include GST.
Donations Would you like to make a donation?
Yes
If yes, how much?*
$
No
*GST does not apply. Donations over $2 are tax deductable.
Total costs Membership fee plus donations
$
The Hepatitis C Council of South Australia Inc. is aware of the need for privacy and endeavours to comply at all times with the Privacy Act 2001. As such, any information provided by you is accessed only by authorised personnel and will remain strictly confidential. To change or access any personal information we hold about you, please write to the Manager at the above address. ABN: 38 030 552 547 Tax invoice – please retain a copy for your records.
Proudly supported by:
C
Hepatitis
Community News Spring 2005
Hep C & Prisons • New National Hepatitis C Strategy