Membership Renewal Form
Dying with Dignity Victoria Inc Reg No. A0006974B ABN 80 591 186 892
All fields in bold are required
Step 1 of 3 — Enter Your Details
Title:
Dr Mr Mrs Ms Mr & Mrs
First Name:
Last Name:
E-mail:
A copy of your renewal will be sent to this address.
You need only complete the address details if they have changed since last year.
Occupation:
Current Previous/Retired
Street:
Suburb/Town:
State:
Postcode:
Phone:
(H) (W)
Membership Fee:
Click the appropriate membership type to add it to the shopping cart, then click the Back button to return here and continue. Membership fees include GST.
Annual...
Lifetime...
Donation:
Donations are optional and are GST-free. Click a donation amount and then click the Back button to return here and continue.
You may add multiple values to achieve any total.
View cart contents
Step 3 of 3 — Submit Your Renewal
Submitting your renewal will take you to the shopping cart where you complete your payment by credit card.
Authority:
I/we request DWDV to rewew my/our membership of the Society.
Credit card transactions are made using a secure server.
DWDV accepts the following credit cards for on-line renewals.
DWDV is a self-funded, non-profit organisation, relying on volunteers, membership fees and donations to continue its work for all Victorians.
Fees are deliberately kept low so any additional donation you are able to make also helps us greatly.
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