Membership Form

 
FULL NAME
ADDRESS  POST  CODE
EMAIL
MOBILE HOME PHONE
OCCUPATION
MEMBERSHIP:
Full membership                      :        Yearly A$120.00
Senior & Student Membership   :        Yearly A$60.00
Please make Direct Deposit or Internet Transfer  to:

 COMMONWEALTH BANK

  ACCT No: 1074 7882       BSB: 062-198

 MANOS HEALING CENTRE INCORPORATED

Please Email Filled Form to: [email protected]