MEMBERSHIP FORM Name: Address: Phone No: Mobile No: What illness do you suffer from? Do you suffer from a Mental illness? Doctors Name: Contact details: Next of kin details: What hobbies do you have? Would you like to Volunteer? Do you have a Guardian? if so Name.Contact details: Does State Trustees Manage your finances? If so Name of Administrator: Would you like to return to work? If so what would you like to do? Do you have any Pets? Do you pay your Rent 'Direct Debit' via Centrelink? Are you on 'Long Term' harsh medications? Do you require special food types? Are you mobile, or need mobility assistance? Can you volunteer for DSP Australia Inc events? What would you like to do? Have you received a Loan from 'Centrelink'? to help you receive goods to learn new skills or pay utility bills. Do you have a car? Would you like to join our 'Food Co-op'? Do you need help in your home? All information on this form is 'Strictly Confidential' under the 'Privacy Act' and will not be given out for any reason. Please fill out this form and submitt to DSP Australia Inc for processing your Membership together with a copy of your DSPpension Card. Membership Fee per annum. $20.00 including Membership card, and Newsletter every 4 months.
