NATIONAL TWIN LOSS SUPPORT
OFFICE USE ONLY Username: Password:
Established Oct. 1992
ABN:
69 695 149 922
Postal:
Phone:
0419 039 194
Email: twinloss@internode.on.net
ONLINE MEMBERSHIP APPLICATION
_______________________ _________________________
First & Second Names Surname
___________________________________________________
Postal Address
______________ _________________________
Date of Birth Email Address
_______________________
Occupation
Please tick one of the following to
show your status:
Multiple Birth Loss Parent Friend or Family Member
Volunteer Community Worker Health Care Professional
Other
_______________
Please state
MEMBERSHIP IS FREE!
However, members
agree to abide by rules and guidelines as set out by the National Twin Loss
Support Organisation: I ______________________ agree to keep information which
is shared within the members only section of the organisation’s website confidential,
unless written permission is received from the organisation’s founder for its
use. Unless otherwise stated, all work submitted for publication on the NTLS
website will be regarded as being the original work of the sender.
PLEASE NOTE: Access codes will be emailed to the new member. Newsletters will
be emailed on a quarterly basis. If new member does
not have personal internet access, (e.g. uses internet café, or library
computer), this information can be posted out. Please circle appropriate answer:
Please post newsletter Please email newsletter
______________________ _________________
Applicant’s
signature
Date of Application