SpotonDD Membership Application - Working with people who have a developmental disability

Please fill out the below form to join SPOT on DD, Note send cheque/money orders to:

SPOT on DD
PO Box 2283
Hornsby Westfield NSW 1635

Cheques/Money orders should be made payable to “SPOT on DD” NB Membership is for the financial year (ie 1 July to 30 June)

	I am joining as a full member (SP,OT,PT only)	Joining as an associate member
	Joining as a student member	Joining as a graduate member
	I am purchasing Transport Safety Guidelines

I do NOT want my name and contact details to be given to another SPOT member

PERSONAL INFORMATION (Please note members are responsible to contact SPOT on DD regarding changes to contact details)
name:
address:
address:
city:
state:
post code:
phone:
mobile:
email:

PROFESSIONAL INFORMATION (students don’t need to complete this section)
employer:
work address:
address:
city:
state:
post code:
phone:
fax:
profession:
graduated from:
post graduate / other qualifications:

Method Of Payment
cheque / money order PayPal (credit card)