Existing Membership Form
Name
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First Name
Last Name
Address
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Street Address
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Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
I enclose payment (or confirmation if via direct deposit) of my annual subscription fee:
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$10.00 inclusive of GST where employed and able. Payment can be made to: North Queensland Women's Legal Service - BSB: 064 817 - Account: 10885093
Separate donation amount. Donations over $2 are tax deductible. If choosing this option, please specify below payment amount. Payment can be made to: North Queensland Women's Legal Service - BSB: 064 817 - Account: 10885093
Other amount:
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