AC99 - How to Get Involved

	How to Get Involved Australian Coalition '99

Please note that AC'99 is not affiliated with a political party, and there are no partnership fees involved.

You will need to cut and paste this form into your email to Australian Coalition '99.

National Partner Application Form

Australian Coalition '99 invites organisations wishing to participate in the International Year of Older Persons in 1999 to register as Partners.

Please indicate which category best describes your organisation:

Older Persons Organisation
Organisation Not Exclusive To Older Persons
Research, Tertiary Education, Professional Organisation
Service Provider
Business Sector
Government

NAME OF ORGANISATION

NAME OF APPLICANT (PERSON)

TITLE

STREET ADDRESS

POSTAL ADDRESS

TEL:
FAX:
MOBILE:
E-MAIL:
WEBSITE:

Please provide a profile of your organisation including any details that you believe may be pertinent to ageing and older persons.

Please list comments and/ or ideas on how your organisation might be or is already involved in specific initiatives for the International Year of Older Persons and beyond. You may wish to include a list of organisations whose competencies may complement your own in working towards specific initiatives. Please feel free to include attachments.

SIGNED
DATE

Please return this form to Australian Coalition '99 National. Thank you.
E-mail: ac99nat@cota.org.au

For further information, please contact Lisa Ellis, Jane Inall, or Gwen Gilbert, AC'99 National Secretariat,
Tel: (03) 9820 4463 Fax: (03) 9820 4247

For our information and records, we would appreciate a mailed copy of this application form.

If your organisation or group operates within one state/territory, you are invited to become a partner of that state/territory. Please contact the relevant State Project Officer for more details.

For a complete information kit and partnership application form please contact the National Secretariat.