Autism Victoria Inc Reply Paid 374 CARLTON SOUTH VIC 3053
Delivery Address: PO Box 374 CARLTON SOUTH VIC 3053
Phone: Fax: Email: Web:
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(during office hours) (03) 9657 1600 (03) 9639 4955
[email protected] www.autismvictoria.org.au
Filename: D72104532001110220N090928.pdf
Write: PO BOX 374 Carlton South VIC 3053 Visit: 24 Drummond St Carlton VIC 3053
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M E M B E R S H I P
become an Autism Victoria member today
www.autismvictoria.org.au
Become an Autism Victoria member today
Moisten here
Autism Victoria Inc. – ABN 15 600 724 949
A key role of Autism Victoria is to advocate for improved services and supports for families and individuals impacted by Autism Spectrum Disorders.To achieve this outcome, Autism Victoria must demonstrate that it speaks for many people in its call for improved supports. The best way to achieve this is by increasing the size of our membership base to promote a unified voice that can influence and assist in the lobbying process with Government agencies.
Membership of Autism Victoria is beneficial for anyone affected by an Autism Spectrum Disorder – families, individuals, schools, professionals, agencies or support groups. As a member you are entitled to these valuable benefits:
This form becomes a tax invoice/receipt upon payment. Please retain a copy for your records. Privacy and Autism Victoria – Your personal details are stored securely and only used by Autism Victoria for member communications.
Select membership
1. Families, Individuals and un-funded
$50.00
Mr
2. Concession
$25.00
Mrs
Ms
Miss
Address: Phone: (H)
Postcode (M)
Email:
Tick this box if you would like a subscription to our
free electronic bulletin the E-Spectrum.
A membership card
•
Use of the resource library. You can also borrow and reserve books online using your membership card
Donations and Products
•
Annual subscription to our new look quarterly magazine The Spectrum (4 issues)
to Autism Victoria (a tax deductible receipt
3 free sessions with the family counsellors (face to face at our Carlton office or by phone)
•
Discounted registration fees to conferences and courses run by Autism Victoria
•
Free registration to information sessions run by Autism Victoria
I would like to make a donation of
3. Professionals and funded agencies
$
Autism Victoria
$
I would like
Autism Awareness
$
Please debit my
Mastercard Visa
Card Number: _ _ _ _ /_ _ _ _ /_ _ _ _ /_ _ _ _ Name On Card: Expiry Date: _ _ /_ _ Signature:
Please forward this form with total payment $
Your membership is a positive way of supporting Autism Victoria. Moisten here
$75.00
For agencies, one membership per site or team is required Multiple copies of The Spectrum to the one site can be aranged.
Cheque /Money Order or
I would like
Pin(s) $3.00 (inc GST)
Only holders of a Pension or DVA Concession Card are eligible. Please note that holders of a Health Care Card only are NOT eligible for the Concession rate. Pension Card Holders - please insert your Centrelink CRN Number:_____________________ and sign declaration. I authorise Autism Victoria to confirm with Centrelink the current status of my Commonwealth Benefit and other details as they pertain to my concessional entitlement.
Payment
will be issued for donations of $2.00 or more)
Wristband(s) $3.00 (inc GST)
support groups
(Pension card holders, full time students)
Organisation (if applicable):
•
•
Dr
Name:
Detach and moisten here
What are the benefits for members?
Annual Membership Rates from July 1st 2010
Tax Invoice
