IN Group Form

THE INFLAMMATORY NEUROPATHY SUPPORT GROUP OF VICTORIA INC.

If you wish to join or support the IN Group, print out the form, fill it in, and mail it to the address below.

YES, I am happy to help the IN Group by becoming a member.

I enclose $…....... being for Joining Fee $5, Annual Subscription $10, and optional donation.

Cheques should be made out to the IN Group, and mailed to:

THE SECRETARY
THE IN GROUP
138B PRINCESS STREET
KEW VIC 3101.

Name .............................................. 



Address ........................................... 



.....................................Postcode.............. 



Telephone (Home)................(Work)..................... 



Signed .................................................. 



Date ....................