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 * EmailMobilePhoneTTY
About You * I am deaf/hearing impairedI have a family member who is deaf/hearing impairedI am a health/education professionalOther (please specify)
Please specify *
How did you hear about us? * Royal Institute for Deaf and Blind Children (RIDBC)Deaf Society of NSWPOD GroupSWISH (area)WebsiteThe Shepherd CentreSydney Cochlear Implant CentreParent of Deaf childSchool/TeacherFamily/FriendsOther
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? * Please select...ChequeDirect Bank DepositCredit Card
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