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MEMBERSHIP APPLICATION FORM |
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1. Individual Membership |
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| Other (please specify) |
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| Year(s) experienced |
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| 2. Personal Details |
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| Age group |
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| 3. What would you like to know about? |
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| 4. Consumer training |
| Cancer consumer advocacy training courses offer skills
and confidence for people wishing to be consumer representatives or
advocates. BCAGVic does not run the courses, but can put you in touch
with organizations that do. Please indicate if you are interested. |
| Please send me details |
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(Please click in box) |
| 5. Are you interested in being actively involved
in the BCAG Committee? If so, what skills could you contribute?
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| 6. Donations |
| BCAGVic is entirely dependent on donations to operate.
There is no fee to join. Any donation will help the voice to be heard.
To donate, you can direct credit to our account 06 3498 1025 1372 or
send a cheque, payable to Breast Cancer Action Group, to PO Box 281
Fairfield 3078. If you would like a receipt, please include a stamped
self addressed envelope.
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Press this button once after completing the form.
This will send the information you have typed in the boxes above to
us by email. |
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Click this button to clear all information from the
form (use this only if you want to start again) |
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