Become a Financial Member

Applicant Details

First Name*

Last Name*

Email Address*

Phone Number

Date of Birth

Connection with Muscular Dystrophy

Neuromuscular Condition / Relevant Profession / Other

Agreement with obligations as a member

As a member of Muscular Dystrophy Queensland Limited, I agree to the following obligations:

I will notify the secretary if my address or other contact details change.
I will pay an annual membership fee, and understand that if I don't my membership will lapse.
I understand that in the unlikely event that Muscular Dystrophy Queensland has to close, I am required to contribute a "guarantee amount" of $10 in total towards the company's debts, liabilities and costs of winding up.
I support the purpose of the company, which is to provide services and support to individuals living with muscular dystrophy, neuromuscular conditions and similar other conditions, and their families.

Nomination by existing member

Name of existing member:

Applications for membership must be nominated by an existing member willing to support your application for membership. If you do not know another member, please leave this section blank and we will seek nomination from another member on your behalf.

Membership Payment

Care to make a donation?You may like to add an optional donation to your entry to support Queenslanders living with neuromuscular conditions.

Donation amount

*Donations over $2 are tax deductible and are gratefully received. A receipt will be issued.

Credit Card*

Membership fee of $55 ($50 plus GST) is payable each year.

Financial Membership Annual Fee*

Price:

Total

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Applicant Details

Connection with Muscular Dystrophy

Agreement with obligations as a member

Nomination by existing member

Membership Payment

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