Membership Form

Please fill out the form below.

Is this a new membership or a renewal?
New Membership Renewal of existing membership

Full name *

Organisation

Address *

City *

State *

Postcode *

Phone *

TTY

Fax

Mobile

E-mail *

Preferred method of contact *

About You *

Please specify *

How did you hear about us? *

Name and DOB of child/ren with hearing loss *

Number of siblings in family

Age of child/ren with hearing impairment *

Degree of hearing loss *

Method of Communication *

Assistive Technology *

School *

Type of Support *

Which type of membership would you like?

Individual/Parent Membership: $33 AUD Benfits include:
• Quarterly copy of sound news
• Invitation to upcoming events and seminars
• Discounts to PODC events
• Voting rights at the Annual General Meeting
• Linkages into other support organisations Small organisation/School: $66 AUD Benfits include:
• 1 - 5 copies of sound news distributed to the nominated contact person
• Invitation to upcoming PODC events/ seminars
• Member discounts to events
• Voting rights at the Annual General Meeting Large Organisation: $500 AUD Benfits include:
• 5 copies of sound news to every department/centre
• Space in every edition to contribute articles/ information/ events
• Half page advertisements in each quarterly edition
• Member discounts to events
• Invitation to events/forums
• Voting rights at the Annual General Meeting

How would you like to pay? *

PODC considers your personal information to be confidential and will only be used for our primary function.
For further information regarding your privacy see our privacy statement