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Title
First Name
Last Name
Gender
Date of Birth	(dd/mm/yyyy)
Postal Address
City
Postcode
State
Email
Diabetes Type
Membership Type
Membership Number

Membership Amount $	36
Donation Amount $
Total Amount $	36

Refund Policy Statement for membership and donation

Membership of Diabetes Tasmania is transferable between affiliated state and territory organisations and is refundable from Diabetes Tasmania in certain circumstances on a pro-rate basis. Please phone 03 6215 9000 (in Tasmania) for further information on membership refunds.

Donations made to Diabetes Tasmania are not refundable or transferable.

Delivery details – Membership is for a 12 month period. Your renewed membership card will be posted to your mailing address by ordinary post within seven working days.

© 2010 Diabetes Tasmania. Diabetes Australia - Tasmania trading as Diabetes Tasmania ABN 90 087 092 180.
88 Bathurst Street, Hobart TAS 7000. Phone 03 6215 9000, Fax: 03 6215 9099. For all information regarding our
refunds policy please contact us on 1300 136 588 Monday to Friday 9.00am to 5.00pm, closed Public Holidays.