To
become a valued member of Cansurvive please fill in this form and post
back to the address listed or you can copy and paste this form into
your e/mail and send to:
CANSURVIVE RESEARCH ASSN Nambour Main Branch. MEMBERSHIP FORM Offering information and support for those challenged by cancer. We
welcome members who are not only cancer
patients but members of the caring community who believe in the principles of CANSURVIVE.
ADDRESS........................................................................... ............................................................................................ PC ........................... PHONE: ..............................… .FAX: ................................ Email:.................................………………….. Membership: 1 year $35 2 years $65 I
wish to make a donation $.........(all donations
are tax deductable) If yes, please give brief details. .............................................................................................. .............................................................................................. ............................................................................................. ................................................................................….......... WOULD YOU LIKE INFORMATION ON THE SUPPORT GROUP.?.........................
Signed:............................................... ………………...
Date:.............……………………... Please send this signed form back to CANSURVIVE. With your payment: Cheque, Money order or Credit Card:
Card No: ……./……/……/……/……/……/…… Expiry
date: ………./………... CANSURVIVE RESEARCH ASSN. P.O.
Box 238 Nambour. Qld 4560. Phone:07:5441
5730 |
| We
invite you to become a MEMBER and receive the |