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ABN 38529817275
Charity No:CC26453
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MEMBERSHIP APPLICATION FORM
Please complete and print this form, then post with your cheque, money order or credit card details to Australian Tinnitus Association (NSW) Ltd, PO Box 638 Mascot NSW 1460
Email: info@tinnitus.asn.au
Annual Full Subscription $40 + $5 joining fee
Corporate/Health Professionals $120 + $5 joining fee
Senior Annual Subscription $30 + $5 joining fee
Pensioner Annual Subscription $25 + $5 joining fee

(Note Financial Year 1st January to 31st December, all prices include GST)
As a member you will get the following:
A Tinnitus noise tape (useful for family and friends).
A booklet titled "Beyond Silence" written by Kathy Challinor.
ATA Tinnitus related fact sheets.
A contact list of Tinnitus clinics, self help groups and other organizations.
A list of available books, relaxing tapes and videos sold through the ATA (View).
Our quarterly newsletter "Tinnitus Talk" (latest copy enclosed)
 
Details about yourself
Title
Full Name
Address
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Phone @
 
Payment details
Amount
Pension No. Seniors No.
Donation (Donations over $2 are tax deductible)
TOTAL
Enclosed OR
Please debit my
Card No
Expiry Date
Name on Card