Contact Details Your Full Name * Your Full Postal Address * Your Email* Contact Phone Number* Are you a new member or renewing your membership? New membershipRenewalUpdate of details (no payment required) What's your interest in joining AusDoCC? Individual with a Disorder of the Corpus CallosumParent of a child/adult with a DCCOther relative of a child/adult with DCCProfessional working with people affected by a DCCPerson or organisation interested in DCCs Membership Option Single Membership $20: For all people over 18 wishing to join AusDoCC.Professional Membership $120: For professionals or organisations wishing to join & support AusDocc. Family Details Child 1 or adult with a DCC Full Name Date of birth Gender DCC diagnosis If DCC is associated with another condition, please provide details Child 2 or adult with a DCC Full Name Date of birth Gender Condition If DCC is associated with another condition, please provide details I desire to become a member of AusDoCC Inc. I agree to support the purposes and rules of AusDoCC and accept the terms and conditions of application for membership as detailed on the Association website www.ausdocc.org.au. I declare that all the information given on this form is true and correct. Please Consider making a donation along with your application. All donations over $2.00 are tax deductible. Contact and Privacy The information collected in this form is for the use of AusDoCC Inc. and affiliated branches only. Information is confidential and will not be shared with any third party without prior consent. The Privacy Act 1988 allows applicants to access and amend their personal information at any time. AusDocc Inc. uses email to share newsletters, updates about upcoming events and other resources for AusDoCC members. I wish to receive email from AusDoCC Inc. I consent to be on a contact list for families of DCC. Payment options are Paypal (accepts credit card), and BSB Bank Transfer.
